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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> I further certify, under penalty of perjury, Mat I am(check one): <br /> Legal property owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s)involved in this <br /> application, or - <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf,and that the foregoing application statements are true and correct. <br /> Print Name: l.i!'/ C� i — �,l✓"�f Signature <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> MSNOR$V6XPP POPM R6V. 0-1p-01 IIXNI <br /> -5- <br />