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r , <br /> s - <br />'s <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />` AUTHORIZATKWSI 3NATURES <br /> . <br /> ONLY.THE:OWNER OF THE:PROPER YORANNAEt7FiORQE) .AGENT.KAY.FILE A4 APPLICATION.. <br /> I,the Owner/Agent agree,to defend,Indemnity,and hold harmless the County and Its agents,offlcers and employees from any claim,action <br /> 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,trustor,or corporate officer)of the property(s)involved in <br /> this application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application 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 /> correct. <br /> Print Name: n/,';FTZ Signature: �i.�z�c-�� Date: <br /> Print Name: ,�o NC-i ,4 ��=/y t76� Signature: zz Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />