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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORMATION SIO NATURES <br /> ONLY'THE.OWNEROFTHEEPROPE}�TYbRAN'AUTHORMED'AGENTMAYFILEAN A?FClcAT1dN :: f <br /> I,the Owner/Agent agree,to defend,Indemnity,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the OwnerlAgent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> xLegai property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved in <br /> this application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and . <br /> correct, <br /> Print Name: 02 017 IX �.. / u� Signature: ate: 7 <br /> p <br /> Print Name: V T e a bl,, C Z. Signature. pate: Z 7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> p.; Wk.. - _ +o..eow .1411 <br /> Print Name: Signature: Date: <br />