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$ APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . `} A1HL4TIbyoAiU= . . Owl <br /> '4;: .,' ow d { �: Ft C7 t:i PER,sOft N% " OR :aQ i4 R" i"t' 14" .AP CA710 rFe a yea <br /> s <br /> 1,the OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officels and employees from any claim,action <br /> or proceedlnp against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that I.am(check one): <br /> U legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(a)Involved In <br /> this application,or ' <br /> © legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: . � r Signature J Date: 1 r —U ) <br /> Print Name:V" SA�r � y hirt3: Date, <br /> i Print Name:t7� �� �,¢ i ti/ 1' a4S73ignature: Hate: /( 4�—� <br /> Print Name: Signature: Date: <br /> I Print Name: Signature: Date: <br /> I <br /> f - <br /> 1 " <br /> - - __ -F..e`ar�---'�— -�.r--�:: .- �s`',. -, �e'�.�-mss--._._a�_=s •Y��ae--�--- '�_--,�-� .=w�c.�-� <br /> a <br /> —4— <br />