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tom;= <br /> USE PERMIT ` . <br /> SAN JOAQUIN COUNTY COMMUNITY D LOPMENT DEPARTMENT <br /> "� <br /> "AR <br /> ; s .r FF .AUTHORlZAT DN SIGMATURES ," .. 3 a 'h. �� <br /> ice" "yt.•, .Fi�,�ir`t!'* ""`�''.'�X`' r .'" <br /> ONLY,>;TNEOWNER,OF�FfEf+ROP,ERTY,OR�3N:AUTN R17�'D,AG TMA.Y.FILE4N:IIPRLJCAVON: <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 /> I,further, certify under penalty of perjury that I am(check one): W <br /> 1 <br /> o Legal property owner(owner includes partner, trustee,trustor,or corporate <br /> officer)of the property(s)involved in this application,or <br /> o Legal agent(attach proof of the owners consent to the application of the <br /> property's involved in this application and have been authorized to rile on their <br /> behalf.,and that the foregoing application statements are true and correct <br /> Print Name: Signature. Date, <br /> Print Name: L 4 Signatu kDate. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />