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APPLICATION - MINOR SUBDIVISION <br /> `? < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> = FILE NO: MS- <br /> -.FORS <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I,the Owner/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 Owner/Agent's project. <br /> I further certify, under penalty of perjury,that I am (check one): <br /> Q 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 /> I Q G <br /> Print Name: j�6�/A /�OlJIL/�UE2 Signature: Date: U/o <br /> Print Name: �>�GLL "A9a '� Signature: 7 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F ADEVSVS\Planning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />