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APPLICATION - MINOR SUBDIVISION <br /> �i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> " W' FILE NO: MS- __ <br /> r AUTHORIZATION SIGNATURES <br /> OJ� Y?TfiEEt ©I ,A►1'AUTHORIZED AGENT MAY FILE AN", tit <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 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: L4 O lD �ST/Yl/��PY Signature: X Date: <br /> Print Name: .L lOb h , fEHJ(/ gTP7 , V,Signature: X Date: <br /> Print Name: Signature: // Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F ZEVSVS\Planning Application Foansxminor Subdivision(Rev. 12-09-04) Page 7 of 9 <br />