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f <br /> r APPLICATION - MAJOR SUBDIVISION- <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> XX <br /> AUTHORiZAT�C)N S[GNAT€IRES <br /> ONLY THE 4)VYNI~R OF CHEPROPERTYOR AN AUTHORIZl=E3 AGEiVt r M1tiY Fit E AN APPLiC,4TiON.. <br /> 1,the Owner/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 /> I,further, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> C 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: /" O Signature: _d "'_�' "„"�"'y� Date: /2 Z i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> r <br /> C <br /> - i <br />�.-:»�..rc� -,-.-„'� ._ � .�._..R.._�.�...-w.. -.;�.�..� :— ....--,...� ... -....-.. .� .....'.r+.n—. w..a.--.es�-+--aP”' .-wc.-,x•-: :.nr`- <br /> 1 <br /> -5- J� <br />