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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS-- <br /> AUTHOR IZATION <br /> SAUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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, <br /> action 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,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 /> Print Name: Gerald A. Robertson, Trustee Signature: 1/' �aX�r�C�--� Date: y-/, c �; <br /> Print Name: — _ _ Signature: Date: <br /> Print Name: _ Signature: Date: <br /> Print Name: _ Signature. __. _ Date: <br /> Print Name: _ Signature: _ Date: <br /> - i <br /> FIDEVSVS\Planning Application Forms\Minor Subdivision(Rev.12-09-04) Page 5 of 5 Job No 2005-87 <br />