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p44!N <br /> APPLICATION - MINOR SUBDIVISION <br /> "t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> �qC/FOR�`4 <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 ownefs 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 We and correct. <br /> Print Name: (JEl7�rh. �W',��f�'�� /� Signature: Date: !D-/S'Zly}8• <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F?DEVSVStPlanning Application FormslMinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />