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APPLICATION - MINOR SUBDIVISION <br /> K <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> cJ FILE NO: MS- <br /> ORt- <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 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 owners consent to the application of the property's involved in this application and have been <br /> authorized to file on their bbeehalf.,andthatthe foregoing application statements are true and correct. <br /> Print Name: V P.(71)Q. A . C] c,\A u Signature: -64 <br /> Print Name: Ci1Qa 10� iC. Jn�ul��. Signature: �\ Date: S-LZ-d6 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />