Laserfiche WebLink
APPLICATION - MINOR SUBDIVISION <br /> ;AN 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 Ownpr/AgonVs project. <br /> I further certify, under penalty of perjury,that I am (check one): <br /> ❑ Legal property owner(owner includes partnc r,trustee,grantor,or corporate officer)of the property(s)Involved in this <br /> application,or <br /> Legal agent(atta�ll.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 correeL' <br /> Print Name: �Ae2� JG� nsrn^� Signatur . Data: <br /> Z^ 13-f�5 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Data: <br /> F:0EV5V5WIanning Application Fa ms\Minor SWawision(Rev. 12-09-04) Page 7 of 9 <br />