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APPLICATION - MINOR SUBDIVISION,yy;. .;:., ;.;,(..1•, ••. 4 . • SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> gvyf�r: �`�M;.,.'Y A O TID rdAFl1R <br /> E OR 14 <br /> I.the Owner/Agent agree,to defend,Indemnify <br /> or proceedln�against the Owner/Agent's proect,d hold harmless the county and Its agents,omc <br /> ' A!s and employesa from any eialm,action <br /> I, further, Certify under penalty of penury that 1 am(check one): <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate <br /> this appllcallon,or. Officer)of the proe s <br /> P rty( )Involved In <br /> 0 Legal agent(attach proof of the owner's consent to the application of the ro <br /> and have been authorized to Nle on their behalf.,and that the foregoing applie�tlon s��ementa a�ifrue and Uon <br /> correct, <br /> Print Name:fy <br /> Signature: ' <br /> PrintName: Data: L d/ <br /> Stena e: <br /> Print Name: �2�✓/�� Date: <br /> Signa re: <br /> Print Name: <br /> Date: <br /> Signature: <br /> Print Name: /yf�jt?yT Date.- <br /> Signature: <br /> ate:Signature: <br /> ate: <br />