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APPLICATION - MItR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION 510NATURES <br /> -ONLY THE OWNER 6F THE:PROPERTY O(t AN At17NORIZED.AGENT MAY FILE AN 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 /> C' 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 appl tion of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the regoing application statements are true and <br /> correct. <br /> Print Name: L �b�,�C� `d '� �igp ature: Pi� ` Date: GJ <br /> Print Name: F6 f L> CC AYOI�C fiInature: 7 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -5- <br />