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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ; , ^••?���• : 11121ournin TIO ONA711RE <br /> I,the Owner/Agent agree,to defend,Indemnlry, < ON <br /> , e Owner/Agent <br /> against the Ownfend,I n e project,d hold harmless the County and Its agents,offic <br /> gra and employees from any claim,action <br /> I,further, certify under penalty of perjury that tam(check one): <br /> Legal Property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In <br /> "a application,or, <br /> 0 Legal agent(attach proof of the owner's consent to the apPllcatlon of theroa <br /> s Involved In <br /> and have been authorized to file on their behalf.,and that the foregoing appllcaUon rtystatements areltrue and appUcaUon <br /> correct. <br /> Print Name:f <br /> Slpnature: <br /> Print Name; Date: f <br /> Print Name: Signa a• <br /> �2�✓/�s� ��✓ t' Date: <br /> 3lgna ro: !1 <br /> Print Name: Date: <br /> Signature: <br /> Print Name: /�f�ji?s/�}N�� � Date: <br /> Signature: � <br /> ata: —Q <br />