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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 7the.0wnerlAgent agree, to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> inst 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 /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to rile on their behalf.,and that t he foragoing application statements are true and correct. <br /> Print Name: i/C 11 d e 12 A— * Vro i' Signature: Date: <br /> Print Name: f� <br /> ;)Csy Signature: ` . t Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> M!MORSUBAPF FORM REV. B-10-01 1111D1 <br /> r <br />