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i <br /> USE PENT. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Mill <br /> L i�?3S :�54^ ,. AUTHQRIZA`TlONSICNATURE � a; <br /> '�.. - v,'� '�,a FSR o- ,3>e s `�.k Ary�Pj;� ry ��i�;ta �i"'.,.:m :.-= �'s- a c j3� ^;, <br /> l Yz„'� ��.;, _ ,ONL.Y THE OWNER bR THE PROPERTY OR-RN Au,TNO,RIZED AGENT MAY FILE AN'APPbCATION <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 1 am (check one): <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 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 applicationsteMents are true and ect. <br /> Print Name: IV �2•ja- W-¢S E� CAIN - Signature: Lo-2-2'n' <br />' f <br /> Print Name: Signature: Date: <br /> 1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: 1 <br /> Date: <br /> Print Name: Signature: <br /> iEy3 <br /> i <br />