Laserfiche WebLink
i <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> :A <br /> uTi4oRtrATKw.sx NATURES <br /> ONLY THeovYNER OF THE PROPERT.Y.OR/UffAiLj H. Q .AGENTMAY FILE AN APPLICATION.. <br /> I,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,off vers 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: Signature: Date: /l --2 3—I d:' <br /> Print Name: 1 Rz fy Signature: Date: Z 3 -21 <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />