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F APPLICATION MINOR SUBDIVISION <br /> u 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 County arising from the Owner/Agent's project. uY� <br /> I further certify, under penalty of perjury,that I am(check one): Y <br /> I� Legal property owner(owner includes partner, trustee,grantor, or corporate officer)of the property(s)involved in this <br /> aoDlication, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the propertys involved in this application and have been <br /> II aumonzed in file on their behuif., ai ai it rai d ion guintt,appiication statamnnis are true and coi-. :... t <br /> IIA }/-��/ <br /> N Print Name: i Signatur "- /,1�,�� Date: Y1161ron'l <br /> q Print Name: Signature: Date: <br /> priii it i.aTc: SL•••••�•••••. nefn <br /> Print Name: Signature: Date: f <br /> IPrint Name: Signature: Date: <br /> rADEVSVSWIanNng Application Fo slmmor Subdivislo (Rev.o61i-09) Page 7of9 <br />