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` r <br /> "- ` APPLICATION - MINOR SUBDIVISION <br /> a, 1 <br /> '� `•' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> 1 <br /> S- <br /> 51 <br /> `FOPY <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 are true and correct. <br /> Print Name: John Vander SchaafJ �,/I <br /> Signature: rr �� Date: <br /> Print Name: Henrietta Vander Schaaf Signature: ate:/0 l-,5 Qi <br /> Print Name: Signature: Dater <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:`.OFVSVSIPlanning Application Foms\MinorSubdivision(Rev.12-09-04) Page 7 of 9 <br />