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. .,. <br /> �: .••..,g� APPLICATION MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />` FILE NO: MS- <br /> R�lfio• <br /> l AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> k 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 County arising from 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: . Signature: <br /> Print Name: Jlk, �.1_L+�_ Signatur Date: <br /> Print Name: 7aj1-o T�nw w Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVSIPlanning Application FormsWinor Subdivision(Rev.06-11.09) Page 7 of 9 <br />