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USE PERMIT"' <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> w <br /> •y _ ?, a .` { . <br /> ,... « ?ret€ by _''�.e�':2:3'e x?ti' <br /> � ,,� t]n"�l'�fhe`C�?�nnerof;h'e�Pro� �e ��'�an�utl�or�lzea�.��1 <br /> /,the Owner/Agent,agree to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> E action or proceeding against the Owner/Agent's project. <br /> 1 further certify,under penalty of perjury, that 1 am(check one): <br /> p Legal property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s) s <br /> Involved in this application,or <br /> D 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 /> r� <br /> Print Name: Signature: Date: <br /> Print Name: Signature:, Date: <br /> Jl] <br /> Print Name: �Slgnafur . Date: , <br /> } Print Name: V b L .�` r — fJnature e <br /> Signature: Date: <br /> PrintlVame: g ` <br /> i <br /> I <br /> i <br /> __� �.r_.�,�� ;•-����..,:�: ..,�._.:�_-� _. _.,rte <br /> UPAPP FORM REV.8-75-02(IND) F <br />