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k --. A <br /> 5 <br /> APPLICATION - MINOR 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 /> 1,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 County arising from the OwnerlAgent's project. <br /> I furrtrcthercertify,under penalty of perjury,that I am(check one): <br /> Lam' .Legal property owner(owner includes partner,trustee,grantor,or corporate of#icer)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: .�l GSC �C OS TQ Signature: Date: r �/D <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date. <br /> Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> I <br /> II <br /> I <br /> 1 <br /> I <br /> F:1DEVSVS1PIanning Application FormsWinor Subdivision(Rev.05-41-09) Page 7 of 9 <br />