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APPLICATION - MINOR SUBDIVISION <br /> L SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '� 3 —1111. TFtORlL4TibN�S10NRfURE VY <br /> Fi t P>rR: R Ns t?R ;7t0 f FT { AP. A710N. :. <br /> 1,the Owner/Agent agree.to defend,Indemnify,and hold harmless the County and Its agents,offletva and employees from any claim,action <br /> or proceedln,g against the Owner/Agent's project <br /> 1,further, certify under penalty of perjury that l.am(check one); <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> Q legal agent(attach proof of the owner's consent to the application of the property'*Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing applleation statements are true and <br /> E correct. <br /> f <br /> Print Name: A Signature. ' Date: <br /> e2 0 <br /> Print Name: TI I- Signature: ,� ate: <br /> la I <br /> Print Name: e .J�b It I/!tyt D e <br /> 1 <br /> ►/ Signator C date: <br /> Print Name: Signature: Date: <br /> ` Print Name: Signature: Date: <br /> I , <br /> +i <br /> t <br /> II <br /> k <br /> I . <br /> I <br /> k <br /> e <br /> f <br /> �. <br /> -4- <br />