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" APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> C/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 /> ® 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 /> AS INDIVIDUALS: <br /> Print Name:Allen S.Thomsen Signature: Date: <br /> Print Name: Thomas L. Thomsen Signature: Date:.4 z1' X4 <br /> Print Name: Kenneth J. Thomsen Signatur — Date: 6�–/—O� <br /> Print Name: Kathleen R. Reinstein Signatur ' Date:(, [1�e <br /> AS THOMSEN FARMS, INC.: <br /> Print Name:Allen S.Thomsen Signature: ,• Date: <br /> Print Name: Thomas L.Thomsen Signature: Date: 7 ^OG <br /> Print Name: Kenneth J.Thomsen Signatur Date:L ZZ'�{0` <br /> Print Name: Kathleen R. Reinstein Signature: Dater={J� <br /> F:\DEVSVS\Planning Application FormsWinor Subdivision(Rev.12-09-04) Page 5 of 5 Job No.2005-54 minor sub <br />