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��utN r <br /> _' e° APPLICATION — MI <br /> NOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> l 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 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: gIng! tXb Signature: �!` Date: Oxo�/Print Name: /@ <br /> v i a Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: i <br /> Date: , <br /> Print Name: Signature: <br /> Date: <br /> I <br /> I <br /> F 4DEVSVS1Ptanning Application FormsWinor Subdivisbn(Rev. 12-09-04) Page 7 of 9 <br /> 1 <br />