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0 <br />.��.� ■ �v1Y - id1A�YV1i �ulSVI V f, <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NO: MS- <br />L!] <br />I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or <br />proceeding againstthe 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 b <br />authorized to file on their behalf., and that the foregoing application statements are true and correct. <br />Brad Lan I� t <br />Print Name: Lange 5ignature: 1 Date: c 1o <br />Print Name: Randell Lange Signature: Date: �CJ��j ;/Z <br />Print Name:c <br />Signature: Date: <br />Print Name: Signature: Date: <br />Print Nate: Signature: Hate: <br />F \%\1)EVSVS1111Planning Application Forms\%N\Minor Subdivision (Rev. Page % of 9 <br />12-09-04) <br />