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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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,action or <br /> proceeding against the OwnenAgent's project. <br /> I further certify,under penalty of perjury,that I am(check one): <br /> O Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)Involved in this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> f have been authorized to file on their behalf.,and that the foregoing application statements <br /> ���are <br /> ���true and correct. <br /> �'7/- <br /> Print Name:\Ilif79. 1i• G{J1LlI fYM JrT Signature: j L��Date: <br /> Print Name: Signatu Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> MINORSUBAPP Po1L4 REV. 9-10-01 IIHOI <br /> -5- <br />