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Y U USE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 7 <br /> 7' <br /> W 'OU. <br /> -s NA <br /> ji T ORIM. .T IG T <br /> ........... <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, <br /> officers and employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> 0 Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> officer) of the property(s) involved in this application, or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the <br /> property's involved In this application and have been authorized to Me on their <br /> behalf., and that the foregoing application statements are true and correct. <br /> Print Name: Gqrd-"o r, (4 Signatu Date. <br /> f <br /> PrintName. JEW-4 Signat Date: /V <br /> Print Name: Sign ure. <br /> Date:tp tv 1131 <br /> Print Name., -- I a nn Signatu Date*45 <br /> Date., <br /> Print Name: f A,0,-W- Signat <br /> _z2ZtLL ,0- <br />