Laserfiche WebLink
A'PPUCATION A'MINOR SUBDIVISION <br /> SANjQAQU1lY C0yff7yC0WUM17Y,DEY1RL0PMEMT DEPARTMENT.. <br /> .:s <br /> 1:r <br /> ONLY Tl OWMER O�TF1E'PRd 3TY I�F1C AN <br /> 1,fire Ownen+Apent sgrw%to defend Indemnity,and hold harms tithe Cos W&W Its ayepte,o#Xcera end enjak m front apt chits,acdm ar <br /> lroceedi+r9 mgakW the OWWAVenrS PrloWt. <br /> 1,further, certify under penally of Perjury that f am(check one): <br /> ® LMW property owner(owner Includes pw**w.kustes,bugoror corporate oflloerJ of On PmP*10(a)Involved In this <br /> apPllcatTon,or <br /> O Legal spent(attach Proof of the owners consent to the apOpllcsflon of the property's Involved In Oft appflcadw and <br /> have been audmrized to Mean their bob&%,and loaf die foregaft aPPlkaflop shtemaab an tare and awwL <br /> Pdnt Name: 6=er <br /> Signature. Dab: <br /> Print Hone: SJynabure. Deb <br /> Print Name: Signature: Data <br /> Print Name: Signature: Data. <br /> Print Name: Signature: Deb: <br /> -5- <br />