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•QuIM.. APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <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 /> ® 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 owners 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 /> 7 <br /> Print Name: Charles E. Skobrak Signature: ��,/' �"/'"'( ; ate: (o" t O-OK <br /> Print Name: Donna Mae Skobrak Signature:!S .�AA-%, /-1 a..t_s�r J�+wr Date: 1� -/D -o ZS <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FIDEMSPIanning Application Formswinor Subdivision(Rev. 12-09-04) Page 7 of 9 <br />