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APPLICATION - MINOR SUBDIVISION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NO: MS- <br />AUT�10RI�ATION 5IGANATyRAS: <br />ONLYTHE:OWNER OFTWEPROP-ERTY�OR'AN''AUTH{3RIZ D GEN, TtMFILEfAN'#'APP IGATON <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:+tyL MiSignature: Date:�`id <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />F:1DEVSVSWlanning AppllcaGon FormsUnor Subdivision (Rev. 12-09-04) Page 7 of 9 <br />