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Dec. 2004 2: 24Pv1 BMETT DEV <br /> "= APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: M$- <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 OwnedAgent's project <br /> I further certify,under penalty of perjury,that I am(check one): <br /> -121�111 egal property owner(owner includes partner,truslea,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 tree and correct <br /> Print Name: LGgomc�r51no Slgnaturw( Date: <br /> Print Name: Signature: Data: <br /> Print Name: Signature: Data: <br /> Print Name: Signature: Date: <br /> Print Nance: Signature: Daft: <br /> F:ICEvaVStPlsnring AXIft Wn FGMS!,/WOR SUBDIVISION tRe .6-a0d) Page 7 of 9 <br />