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r aop4?t?ry,. <br /> E' ° .PPLICATION - MINA SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS <br /> •.�4<i F iSRc+�p: <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 /> Lel 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 /> Print Name: L C"t*, 5 Lam . 3- Signature: <br /> Print Name: yo4wzwo, Cyst _ Signature: 112A Date: I W6. O <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVS\Planning Application Fonns\Minor Subdivision(Rev.12-09-04) Page 7 of 9 <br />