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oe4� N, APPLICATION - MINOR SUBDIVISION <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATIONSIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> Frthener/Agent agree,to defend,indemnify, and hold harmless the County and its agents,officers and employees from any claim,proceeding against the Owner/Agent's project. <br /> certify, under penalty of perjury,that I am (check one): <br /> (K' Legal property owner(owner includes partner, trustee, grantor,or corporate officer)of the property(s)involved in this <br /> a lication,or <br /> Legal agent(attach proof of the owners 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: _ Z. /Y. X-'R&1Ar,4 Signature: . ate: <br /> Print Name: Signature: : ��2 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEVSVS\Planning Application Forms\Minor Subdivision(Rev_12-09-04) Page 7 of 9 <br />