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APPLICATION - OCR SUBDIVISION <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _-....... AUTFIORIZATIdt1: <br /> SIG NATIIRE&.....>......... <br /> ONLY:THE OWNEROE.THE.PROPERTY.l7RA[�4AEEORIZEDAGMIT;MAYFIL�API APPLICATION. <br /> I,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers 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 /> xx Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> O 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: !L t Signature: a*�w,1� Date: <br /> Print Name: Signature: jyj t/p,; . D.r6>O�oro Date: <br /> Print Na Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -5- <br />