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Op4Ut� <br /> : - APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `•= i' 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 County arising from the Owner/Agent's project. <br /> I further certify, under penalty of perjury,that I am(check one): <br /> ® Legal properly 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 file on their behalf.,and that the foregoing application statements are true and correct. D <br /> Print Name: Manuel Tavares Signature: ate: p��a/�3 <br /> Print Name: Valerie Tavares Signature:-, �� Date: S J400 <br /> Print Name: Signature: Date: <br /> Pnnt Name.- Signature: Date: <br /> Print Name: Signature: Date: <br /> F'%DEVSVSIPIanning Ap.h.bpn Fo M!A,n.,S.bd.ls...(Re.-.os-i i.oe) Page 7 of 9 <br />