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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,Indemnify,and hold harmless the County and Its agents, officers and employees from any claim,action or <br /> 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 /> 0 Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> may— have been authorized to file on their behalf.,and that the/foregoing application statements are true and correct. <br /> Print Name: �-Cg7l� Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> NSpOR666AVV PoPM FtV. 6-10-01 12NC1 <br /> _5_ <br />