Laserfiche WebLink
APPLICATION - MINOR SUBDIVISION <br /> t 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 /> AJ Legal property owner(owner includes partner, trustee, grantor, or corporate officer)of the propeny(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 Utak behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: G/ Signature: _C' <br /> Print Name: / / Signature: `-P Date:/�O,) <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FibEVSMPLamrg Application FomisVAknr subdivision(Rev.12.09-04) Page 7 of 9 <br />