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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ALLTHORlZAT;Ctt SIGNATUR ES <br /> aNLY.THE.OWNER OF:T}-1EPROPERTY OR AAYAFJ7FiOR1ZE�AGEPIT MAY FILE AW OPP�`1CATiON.. <br /> I,the OwnerlAgent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> I <br /> or proceeding against the OwnerlAgent's projec-L <br /> I <br /> I, further, certify under penalty of perjury that I am (check ones: <br /> I <br /> j Legal property owner(owner includes partner,trustee,trustor,or corporate ofticer)of the property(s) involved in <br /> this application,or <br /> Q Legal agent(attach proof of the owners consent to the application of the property's involved in this application <br /> and have been authorized to Me on their behalf,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: c—ICZ1 2 U <br /> 5 L12 Signature: Date: <br /> Print Name: Signatu Date: <br /> t <br /> Print Name: Signature: <br /> Date: <br /> I Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />