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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4 FILE NO: MS- ;� <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I,the Owner/Agent agree,to defend, indemnify,and hold harmless the County and its agents, officers and employees from !any claim, <br /> action or proceeding against the Owner/Agent's project. q <br /> I further certify, under penalty of perjury,that 1 am (check one): <br /> ® Legal property owner(owner includes partner,trustee, grantor, or corporate officer)of the property(s)involved in thi,j <br /> s <br /> application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been <br /> authorized to file on their behalf., and that the foregoing application statements are true and correct.OF <br /> I� <br /> �i <br /> i <br /> Print Name: JOSE LULE Signature: date: I 3 <br /> Print Name: GRACIELA LULE Signature: 7 Date:61qrI <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: jl <br /> j� <br /> Print Name: Signature: Date: <br /> II <br /> ii <br /> i <br /> 11 <br /> j <br /> i� <br /> I� <br /> I� <br /> I I <br /> i� <br /> 3 <br /> `i <br /> I <br /> i <br /> FADEVSVSW1annmg Application FormsM nor Subdivision(Rev.12-09-04) Page 7 of 9 <br /> ry <br /> } <br />