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APPLICATION - MINOR SUBDIVISION <br /> z <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 /> 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 <br /> a�r�e-true and correct. <br /> Print Name: Gurmit S.Jhalli Signature: Date: S—O <br /> Print Name: Surjit Kaur Jhalli Sign ur . te: P s <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FOEVSVSPIanning Application Forms\Minor Subdivision(Rev. 12-09-04) Page 5 of 5 2008-174 Minor Sub-doc <br />