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P4ufN APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <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 c nify, under penalty of perjury,that I am (check one): <br /> Zgal 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: /C�/V"W �r(7�-J IQSignature: (J Date: <br /> Print Name: G 013 Gn} C4 }-�- S Signature: Date: 7 /I-Ols- <br /> Print Name: Signature: Date: - <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> n:\DEVSVS\Planning Application FormsWAJOR SUBDIVISION(Rov. 12-09-04) Page 7 of 9 <br />