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USE PERMIT <br /> k y s SAN JOAQUIN COUNTY COMMUNITYDEVELOPMENT DEPARTMENT <br /> f ` �}1f�"'� k�<e a+°x"�Shan 3¢�'yj"i'ryr� h � q�l��`�,� "'i �r t. I T� - Pie. s�`'• { � <br /> h <br /> ONL":Y;7Nirr,OWNER;OF7N :AROpER-7"Y;{1RANAUTHQRIZED`i4�ENTMAY�F)LEAN ApALICATION <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 /> o Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> V� E officer) of the property(s)involved in this application, or <br /> f E <br /> 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 /> �1 1 <br /> Prin#Name: U 'rw DkK Q� LI.G) Signature: L <br /> te: 571 0 <br /> Print Name: Signature: te: Z <br /> Print Name: Signature: te:Print Name: Signature: te:Print Name: Signature: ate: <br /> l <br />