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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES. <br /> ONLY THE OWNER OF THE OR AN AUTHORIZED AGENTMAY FILE AN APPLICATION. <br /> [:I,,t:hl OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action <br /> oproceeding against the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that 1 am(check one): <br /> O, 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: Li If 0 � Signature: � � elk Date: <br /> Print Name:' Rn�,2 h L.�,m1JAny ht✓�n ptt <br /> /t;1�QQl'sS y Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> -4- <br />