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Ii <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :,...�AttrHORt711TIONSiQN/tTLIRE3: ....,;.: ' <br /> 77 <br /> dNY 7Ht_:OWNER dF THE PROPERTY OR AH aUTHbRIZEO AGENT htAY FIL>=AN APPt 1CATtOtY.: ! <br /> I <br /> i 1,the Owner/Agent agree,to defend,Indemnity,or prockeedfrt a airtsi the and hold harmless the County and Its agents,officers and employees from any claim,action <br /> 9 g OwnerlAgent's project. <br /> I iE <br /> 1, further, certify under penalty, e of perjury that l am(check one): <br /> Legal property owner(owner includes partner,trustee trusto <br /> I this''appilcation,or r,or corporate officer)of the pro <br /> p rty(s)involved in <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the ro <br /> and have been authorized to file on their behalt:,and that the foregoing application,statements ements are true ands Involved In tapp <br /> Print <br /> tica ton <br /> correct. <br /> Print Name: <br /> I� Signature: Date: 3� <br /> Print NA e: Jo <br /> � h Signature: �� , -� � <br /> Print Name: Date: —_ <br /> Signature: <br /> Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Naine: ' Signature: <br /> Date: ._ <br /> I ` <br /> f <br /> i; <br /> .; II <br /> i <br /> i <br /> it <br /> i <br /> is <br /> li I <br /> .w <br /> I� !I <br /> I� <br /> i <br /> �S <br /> I , <br /> -4- <br /> 6 II <br />