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��•c°�� APPLICATION TION - MINOR SUBDI�DEFP!ART2�N]TII <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT <br /> .•. -:,'. ;P FILE NO: MS- <br /> f 9L1F—oRi <br /> AUTNORIZATI.ON SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE'AN "APPLICATION. <br /> 1,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. <br /> I further certify, under penalty of perjury,that I am (check one): <br /> Legal property owner(owner includes partner,trustee, grantor,or corporate officer)of the property(s)involved in this <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. <br /> Print Name: i ! Signature 41, <br /> DatePrint Name: wN N. bp1lN D Signature: <br /> Date: <br /> Print Name. Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> FAVEVSVS%Planning Application FormsWinor Subdivision(Rev..12-09-04) Page 7 of 9 F <br />