Laserfiche WebLink
C. <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> 14gA�a� 1c�N REr7, m.,,,ex, .. <br /> 4J 5=, <br /> _ fl} �1 <br /> %QNt Y Til OWNER{# FIERt7RRTY°OR AICdAUTHQFiJID` 4A�i►Y FILE AN +A�PLI�ATID1 <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: Henry B. Dietz _. Signature: Date: <br /> Print Name:_Greta W. Dietz Signature: Date: 0 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVS�Planning Application Formswinor Subdivision(Rev. 12-09-04) Page 5 of 5 2010-134 Minor Subdivision.doe <br /> 1 <br /> E <br />