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F 'PLICATION - MINUR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> •%FOFt� <br /> • H i� ,T�d`��3t r7:,Sfi"rCis' <#�Yr�;a .r...iie.,: .# © V _f V - ' �z �;.�. <br /> I,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from aany claim, <br /> action or proceeding against the Owner/Agent's project. <br /> I further certify,under penalty of perjury,that 1 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 applicationstate ents are true and correct. <br /> a <br /> Print Name: Wl//y NgOSV Signature: Dte: AQ /0/' O* <br /> Print Name: g <br /> Do%res L I j'►'1 Signature: OW <br /> 11— Date: J2,//UI-�Wq <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> FADEVSVS\Planning Application Fonns\Minor Subdivision(Rev.1-2-03) Page 7 of 9 <br />