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I <br /> - APPLICATION f- MINOR SUBDIVISION. f , <br /> SAN JOAGUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Cs} <br /> Y5 <br /> 49, g,7LLR r#.wY <br /> iAtJTtioRtZAt1bNSIGIYR <br /> :..;•: •.;y P <br /> s <br /> 7URES� <br /> ::ONLY7HE:.04VN$ROF'THe:PROF+E�'y�i�l`tSq�ItAp �aO�NFMAY,`FI�AN:APpI.ICA7lQN.. s� <br /> f,the Owner/Agent agree,to defend,indemnity,and hold harmless the County and Its agents,officers and employees from an claim,ac <br /> or proceeding against the Owner/Agent's project, tion <br /> Y , <br /> 1, further, certify under penalty of perjury that 1 am(check one): <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> Legal agent(attach proof of the own*rs consent to the applic <br /> correct. ation of the property's Involved in this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> I <br /> Print Name: <br /> Signature: C? G <br /> ate: i <br /> Print Name: <br /> Q Q�J Z Signature:, te: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: . <br /> Signature: Date: <br /> Print Name: Signature: -- <br /> Date: � <br /> ... pi <br /> I <br /> I <br /> —5— <br />