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a <br /> APPLICATION - MINOR SUBDIVISION <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: M5- <br /> "S <br /> AUT fFE312pT,lON§j NATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AG04T MAY FILE AN APPLICATION. <br /> I,the OwnerlAgant agree,to defend,indamnlfy,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,litstea,grantor,or corporate offlcal 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 r{e an their behalf.,and that the foregoing appiioatl statements are true and correct. <br /> I <br /> Print Name: O {�, signature; Date! <br /> Print Name: Slgnature. Date: <br /> Print Name: _ _ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FA0EVSVMPWr,ntng Appllotion FornalMlnor3ubdivislon(Rev.oe•tt-tie) Page 7 of 9 <br />