Laserfiche WebLink
APPLICATION - MINOR SUBDIVISION <br /> 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 <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> X Legal property owner (owner includes partner, trustee, grantor or corporate officer) of the property(s) involved <br /> in this application, or <br /> ❑ 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 /> Print <br /> Name: John William Vrieling SignatureDate: <br /> Print <br /> Name: Verla Jean Vrieling Signatur :� ` / JQ� Date: <br /> Print <br /> Name: Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> F:DEVSVS/Planning Application Forms/ <br /> Minor Subdivision <br /> (Revised 06-03-04) Page 5 of 5 Job No 2004-201 <br />