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APPLICATION - MINOR SUBDIVISION <br /> <: 1 <br /> ` f 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 propenyls) 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:v(�/�1e5 {/V ' �/ ! Signature: d �Vi.'1T•� Date: �Z Z7�JS <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Dale: <br /> Print Name: Signature: Date. <br /> F.OEVSVSPbrcOng Application FormsVAinor SuOdHslon(Rev.12-09-04) Page 7 of 9 <br />