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i <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHO>LZA77ON SIGNATURES f <br /> t 1 <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FRE AN APPLICATION. <br /> 1,the Ownen+Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project ; <br /> 1,further, certify u7:0galnatty of perjury that I am(check one): <br /> property owner(owner includes partner,trustee,trustor,or corporate officer)of the propedy(s)involved in this <br /> application,or <br /> p Legal agent(attach proof of the owner's consent to the application of the property's Involved in this application and <br /> ' have been authorized to file on their behalf„and that the foregoing application statements are true and correct. <br /> Print Name: 0?,4r Signature: Date: �T J <br /> Print Name: _ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> i <br /> t <br /> i <br /> f <br /> 3i <br /> 1 <br /> I <br /> k <br />