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• " APPLICATION USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .....:: .........:.....:: ....:::vr --ry>i:::.i.L: :i.:::i:=:]<:.: r .....+..;;.; <br /> .i:.�.:...::. _ :•...........i-r.:.o.K : .:..,c::.:...v.-...A.::..:F .........Y:.�r-�C ..::•:o.v..f:{F..:4t....�..: ...:•.. y:. _ <br /> ::..}..�I.h:: :.:{..-.5.......:. .../..n::5`?.:: ..:).�i;.:J...ti..Yf�h"`pi:::•.: ::...r..i.., ` <br /> »i r y.4.. F <br /> WNAXX <br /> W'3-`''c? <br /> I, the Owner/Agent agree,.to defend, indemnify;and hold harmless the County and its agents, officers and j <br /> employees from, any claim, action or proceeding against the Owner/Agonies project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> DiK Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> of the property(s) involved in this application, or <br /> p Legal agent(attach proof of the owners consent to the application of the property's <br /> involved in this application and have been authorized to file on their behalf., and that <br /> the foregoing application statements are true and correct. <br /> Print Name: /r,�,4G/ GlELL�,QLE/L�Signature: <br /> Print Name: 57 ,rJGE L LEIL�ignature: .Date: <br /> Print Name: Signature: Date: <br /> Print Name:. Signature: Date: <br /> Date: <br /> Print Name: Signature: <br />