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APPLICATION - MINOR SUBDIVISION <br /> I < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> *•, 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 County arising from 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:G� �3S� Gt1l1 Signatur �f��/' ' T ` lw <br /> Print Name: Yv • � Signature: <br /> Date:I .ILA 2 D f e <br /> Print Namei.h•��� �Qe� _. _ _ Signature: 7(1LL1� � Z _ Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Bonner Mendez Lillian W. Hazard <br /> PO Box 126 3400 Wagner Heights Rd. <br /> Linden, CA 95236 Apt. 322 <br /> Stockton, CA 95209 <br /> FADEVSV&PIanning Application FormsUnor Subdivision(Rev.05-11-09) Page 7 of 9 <br />