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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "":' ::, :} ' is lr;�•rs x:+.� a;. <br /> �'�.'• i.` i•£�'�,' P:T4, <br /> ARiTHORIZATION?ild ATURt35k a <' <br /> I� <br /> ORLZ7= ;ip IVI2 a I < ;... . <br /> I.the OwnerlAgent agree,to defend,IndemnW,and hold harmlass the County and Its agents,oMcels and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I.arn(check one): <br /> [� Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of <br /> this application,or the property(a)involved[n <br /> , <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 the on their behalf.,and that the foregoing appiicallon statements are true and <br /> correct. <br /> Print Name: Sl <br /> gr:ature: <br /> Date: <br /> &z,!-,;-. <br /> Print Name: Signature: <br /> Date: <br /> Print Name; Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature; <br /> Date: <br /> I <br /> F <br /> I <br /> 4_I�':'`r=-ao--.�.�•.+r:-rra--ate -.. _ '_ -^ .. _. - - - <br /> f <br /> F <br /> f <br /> —4- <br /> -4— <br />