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• P+u rp <br /> Ac APPLICATION - MINOR SUBDIVISION <br /> (a`i < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . FILE NO: MS- <br /> dlFONd <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 County arising from the Owner/Agents 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 owner's consent to the application of the property's involved in this application and have been <br /> authorized to file on <br /> 77:their behalf.,andthat the foregoing application statements are:trueand correct. <br /> Print Name:e:ROVKo.td �.�e.yN9 Signature:. '. Date9/%4�7 <br /> Print Name: L�rPtNr ) ILLL fT Signature: Date:407 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date. <br /> FADEMSTlanning Applicafion Fonns%linor Subdivision(Rev.06-11-09) Page 7 of 9 <br />