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qu1N <br /> APPLICATION - MINOR SUBDIVISION <br /> ?< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> ���iFURa`•P <br /> AUTHORIZATION SIGN/4TURES. <br /> ONLY:THE OWNEkOF THE PROPERTY OR AN AUTH012ED 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 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: r rrOPJ7)/9�l/D Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application FormsWinor Subdivision(Rev.05-11-09) Page 7 of 9 <br />