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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUFt}ORIZATfC4N 31GNAFURfS <br /> CNtYTHFO[�YNER C>f THE PRtiPERTY LfR:AN A tlFHl7RIZEA AGENT MA1FfttE AN+4f'Pl.tGAF1fMf <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> C3 Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 Legal agent (attach proof of the owner's consent to the application) of the owner of the property(s) <br /> involved in this application and have been authorized to file on their behalf, and that the foregoing <br /> application statements are true and correct to the best of my knowledge and belief. <br /> Print Name: Kenneth L. Kjeldsen Signature: ;;,y, ate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />