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' Q <br /> 0.-Z. <br /> APPLICATION <br /> - MINOR SUBDIVISIO <br /> SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1 FILE NO: MS----------------- <br /> $fi <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 /> 1 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 /> ❑ 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 /> Print Name: <br /> �t=F ���•IV4r3C> Signature: �(.� Date: �I— �v—aJ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F ZEVSVS\Planning Appiwm,n n Formswinor Subdivissan(Rev.6-03-04) Page 7 of 9 <br />