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4ur~ APPLICATION - MINOR SUBDIVISION <br /> (y < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \\o\ikoaP�P• <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 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 /> 17 <br /> Print Name: °It j� "`�o j� Signature: ct Dater <br /> Print Name: Q.SSqn Signature: 04� Date: q./d-0) <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVSTlanning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />