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s '�P <br /> APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> - iS <br /> ....:. <br /> :,::0l1lLY THE OWNER OF THE PROPERTY OR ANAUTHORIZED AGENT MAY FILE AN APPt1CAT10NAl <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> a Legal property owner(owner includes partner;trustee, trustor, or corporate officer) <br /> of the property(s) involved in this application, or <br /> o Legal agent(attach proof of the owner's consent to the application of the property's <br /> involved in this application and have been authorized to file on their behalf., and that the <br /> foregoing application statements are true and correct. <br /> Print Name: Alfrgrl P. Ppmhn Signature: ",/- <br /> per• "'��i <br /> Print Name: Signature• per. <br /> Print Name: Signature: Dom- <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br />