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n <br />p•HGZU11y L' <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 />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 1 am (check one): <br />Legal property owner (owner includes partner,'trustee, grantor, or corporate officer) of the property(s) involved in this <br />r application, or <br />i❑ 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 />. �. <br />PrintlName: �� Signaturlt!p <br />} Date: <br />Print'Name: �-+m Signatur Dat: �Ctb- <br />Print',Name: Signature: Date: <br />Print''Name: Signature: Date: <br />Print I'Name: Signature: Date: <br />i <br />F:OEVSVMPlanning Application FormsWinor Subdivision (Rev. 12-09-04) <br />Page 7 of 9 <br />