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APPLICATION - MINOR SUBDIVISION <br /> 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 /> ffl ,r::�;erlAgent agree, to defend, Indemnify,and hold harmless the County and its agents,officers and employees from any ctaim, <br /> roceedingagainst the County ans riq from the Owner/Agent's project, <br /> 1 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(&)involved in ttus <br /> application,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 /> -DY, . 1 mut E eaf-P, &-6Weg t <br /> Print Name. X $ 12PT-Ad!gt� MC. V&0—Signature: X Date: <br /> Print:'Name: -_- Signature: Date: <br /> Print Name: Signature_ pate_ <br /> Print Name: _ Signature: Date: <br /> Print Name: Signature: Date: <br /> F,D1=-vSvS"a;mlrg Aopkafiw Formsftnor Suhdtvisi (Rev.05.11.09) Page 7 of 9 <br />