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19 <br /> ^quiN <br /> APPLICATION - MINOR SUBDIVISION <br /> " SAN 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 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 /> ❑ Legal agent(attach proof of the owners consent to the application of the property's involved in this application and have been <br /> authorized to rile on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: �1 �k�,. �Ko — Signature: Date: —O 6 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEV5VSV11anniN Appkadon FormsUnor Subdivision(Rev.12.09-04) Page 7 of 9 <br />