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SOO <br /> (W*r <br /> APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> oh� <br /> AUTHORIZATION SI QN ATUR ES <br /> ONLY THE QWNER OF THE PROPERTY OR AN AUTHORIZEb AdIkNT MAY PILE 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 /> Q Legaf 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 <br /> �statements <br /> � are true and correct. z <br /> �/V"F T �� - / ,� _�lJa-.v�� . Date: <br /> Print Name: � r Signature: <br /> Print Name: ob 6n} Ca Signature: Date: 7-19'6 <br /> Print Name: Signature: Date: . <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> L. <br /> L <br /> L <br /> L <br /> L <br /> L. <br /> L\D6vsv5YPIsnnln0 Appl4srbn Ponn3VvlA.IOR SUBDIVISION(ROY. 12-09-04) Page 7 of 9 <br />