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p4U'N APPLICATION - MINOR SUBDIVISION <br /> N; 5 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> 'dClkoal' <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 /> [a' 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: txvlcw f - Signature: Date: <br /> Print Name: �p�i2-��h'i n[? L (%1 p r[' 1 G Signature:L Date:(p I <br /> Print Name: ^\ S(D <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FIDEVSMPlanning Application FonnswinOr Subdivision(Rev. 12-09-04) Page 7 of 9 <br />