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Y <br /> f APPLICATION - MINOR SUBDIVISION <br /> r. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AtJ7HORIZATIONSiC3NA7URE5. $ <br /> r� <br /> :<:CNLYTN OWNEffiOt EpRDPERTYORANAUMORMWAGENT.MA-:FIL•S/iWX;0t1CATiON.. <br /> .... <br /> f,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officals and employees from any claim,action <br /> or proceedln.g agal6s-t 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,trustor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> 0 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 /> r r / <br /> iPrint Name: l ( Signature: . L�v �✓l�'ziJ Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> t <br /> I <br /> t <br /> I <br />� f <br /> t <br /> -9- <br />