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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUfN 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 /> 1, 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 /> James La Velle and Angela La Velle <br /> Print Name: James La Velle Signature: Date,c l / <br /> Print Name Angela La Velle Signature: Date <br /> Print Name: SignatureDate: <br /> Print flame. Signature: Date. <br /> Print Name: Signature Date: <br /> 4 <br /> f <br /> I <br /> i <br /> I <br /> I <br /> F',DEVSVSIPIannmg Application FormslMinor Subdivision(Rev-42-09-04) Page 5 of 5 <br /> 2011-209 Minor Subdivision.doc <br /> r <br /> A <br />