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Pqulry <br /> APPLICATION - MINOR SUBDIVISION <br /> 2: - <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> d.. <br /> FILE NO: MS- <br /> 9r�FOR�`� <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 /> xLegal 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 <br /> file on <br /> on their behalf.,,and that the foregoing application statements are t+ruel and correct. <br /> Print Name: (/�iTT�!•4, �L✓�� � f� Signature: L -wV�f�'�r�l Date: 141-/15-_.Zv <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date. <br /> FSDEVSVSTIanning Application FonnsUnor Subdivision(Rev. 12-09-04) Page 7 of 9 <br />