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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .............. . ....................... <br /> ...................... <br /> ........ ......................... <br /> Mam <br /> ............... <br /> .......... ....................... <br /> ................ ............. <br /> N-A <br /> -0. WT.Y.-ORM UT -E A <br /> 66" OP T.-MA; <br /> W YA MO./Z �Gm : YMEA ......... <br /> ................... <br /> ............... <br /> .......... <br /> I tho. n1A1ns=r1ArYznt wirpom to ripfPnd inrlpmniAl and hold harmless the Countv and its acents. officers and emolovees <br /> from.m any claim- actio-n-or-proceeding I against the Owner/Agent's project. <br /> further, certify under penalty of perjury that/am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> C3 Legal agent(attach proof of the owner's consent to the application) of the owner of the property(s) <br /> involved in this application and have been authorized to file on their behalf, and that the foregoing <br /> application statements are true and correct to the best of my knowledge and belief. <br /> Print Name: Thomas M. Zuckerman Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />