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I <br /> , APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> �at i�o-szi'Cp I <br /> i <br /> „AUTHO`RIZATION SIGNATURES `E <br /> :ON.LYFil=OVIfNER GF THE PROPERTY OR AN.AUTHORfZED'AGENT fUTAY 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 certify, under penalty of perjury,that 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 /> ❑ 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: Signature: ,,,,_! Date: 3/21//08 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> I <br /> I <br /> a <br /> F:IDEVSVSIPIanning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />