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sc. 2004 2:24PM 91` NETT DEV No. 1551 P. 3 <br /> =F APPLICATION - MAJOR SUBDIVISION <br /> •: SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE_NO: MS- <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim, <br /> action or prooeeding against the OwnerlAgent's project <br /> I funhar certify,under penalty of perjury,that I am(crack one): <br /> ..0�11.egal property owner(owner includes partner,trusiea,grantor,or corporate officer)of the proparty(s)involved in this <br /> application,or <br /> ❑ Legal agent(attach proof of the owner's mnsent to the application of the property's Involved in this application and have been <br /> authorized to file on their behalt,and that the foregoing application statements are tree and correct <br /> Print Name:aT-hY Layomaxsrno Signature: Date: &-I-Oy <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Data: <br /> Print Name: Signature: Date: <br /> Print Nance: Signature: Date: <br /> R0FV3VSWanning AppO.,WnFomts:Jy%JORSUa6NISION(Rev.64304) Page 7 of 9 <br />