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r. <br /> M � III USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9 .. at eta <br /> 1 �- ra+. NINE< Ra <br /> AUTHQRIZAT1tNSIGJIIq TURES° ' r = <br /> -::i s a ¢. ,t s 't%���� �,t� .s��') �,'.i>x t }s•Y_ a �E w.�L t�� xi ,.o �� ; �tc� a mi' r � �t �q ela: �'t��.r- l„�t a`e t',�:. <br /> ?P'i3"ja'ti �pq'Er,.4`"'•�s.'3 rt» <br /> 1 ONLYTHE+OWNER°OIC,TN P,RQP RTYOR,ANi4UT gRlZEDACaTEN:TMAYFI ,AN,,4PPLlCi4 IpN �t w4,� t <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. i <br /> 1, further, certify under penalty of perjury that I am (check one): t <br /> p Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> t officer) of the property(s) involved in this application, or <br /> X 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 file on their <br /> behalf., and that the foregoing application statements are true and correct: <br /> ' PrintName: !V V 5-n Al Y044( apm LLG) Signature: "r: Date: <br /> ^^" <br /> Print Mame: <br /> Signature: Date: <br /> E <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> jPrint Name: Signature: Date: <br /> i <br /> k <br /> I' <br />