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. � s <br /> USF PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> "0"€ <br /> � E I <br /> a , <br /> AM- <br /> 1, <br /> 1,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 1 am(check one): <br /> 3 L7 Legal property owner(owner includes partner, trustee,grantor,or corporate officer)of the property(s) <br /> Involved in this application, or <br /> Ly Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to rile on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> t <br /> Print Name: Signature: �,4M T-EIC4EIRA- Date:7-0)'-(4 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> !!PAPP FORM REV.8-15-02(WO) 5 <br />