Laserfiche WebLink
APPLICATION - I'tiIIINOR SUBDIVISION <br /> •''1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. j <br /> 1, 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 County arising from the OuvnerlAgent's project. <br /> I further certify, under penalty of perjury, that I am (check one): <br /> ®x 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 /> i <br /> Print Name: Signature: t lv�_ 1'1 N Date: <br /> Print Name: Signature: f Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> i <br /> i <br /> F.'DE�S1rSPunnnq.App afon F�rm;.6Ln�r Subdv;e�n(R?v c^-1-11) Page 7 cf 9 <br />