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APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNI TY DEVELOPMENT DEPAR rMENT <br /> d .,.. FILE NO: MS- <br /> FD <br /> AUTHORIZATION SIGNATURES �I <br /> n Y,_ONLY FHE0IN.�IEIY�O„rTtiF1�F20fEF`YTYOf3;�4P1'AF1FHrpRFZZ�kTAG,FIJT(dAY;F�7LE AN fPh�,l�,ATlf3[J. <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 owners 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 /> PrintName: RtA R-q�-} CA Signature: I Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F+DEVSV31PIanNng Appinatm FIX.SVAAJDR SUBDIVISION(Rev 12-0304) Page 7 of 9 <br />