Laserfiche WebLink
°n¢ :c4 APP'k aCATION — MAJOI, _ SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .� FILE NO: MS- J�o <br /> ••.�/FOR' , <br /> AUTHORIZATION"SIGNATURE S <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Ovmer/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 Ovmer/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 owner's 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. <br /> Print Name: C ( cf C ( 4�iC-K`� t-tt- Signature: Date: 2-- :5-0 ' <br /> Print Name: CI R t-C 1tl to Signature: Date: z `5-C T- <br /> Print Name: G 1� 'C_ Signature: Date: <br /> Print Name: Signature: � � � Date: <br /> Print Name: f�iC-VA(i.y c=I /} I' E �a�,k c f f Signature: ���Grt c /�./ -e- Date: <br /> t <br /> :%DEV5VS1P1anning Appfics5on FcrmsVAAJOR SUBMiSION(Rev. 12-09-04) Page 7 of 9 <br />