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1 <br /> f ' <br /> 4 <br /> u� APPLI ,AYIQN - VARIANCE k . <br /> SAN sOAQU1N COUNTY COMMUNITY DEVELOPMENT dEI�AP INIENT <br /> FILE NU,�+ABER VR- <br /> ►. 1-151 <br /> :.C, <br /> f' <br /> The 1anans;a wilt not authonZe ause or activity which is not:otheri�irt"se etcprs�sly authonzed by fhi3 zone rUlation governing <br /> :r <br /> 11100061Qf property,: f75 L <br /> 4.2 <br /> ��s r Y f,p^1 t i f F pII��H�I llw } � �,�A ��Tt � �G'����� •': <br /> I, the OwnerlAgent agree, to defend, indemnify, and hold harmiess:the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agents project- <br /> 1, <br /> further,certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s)involved in <br /> this application,.or <br /> [] Legal agent(attach proof of the owner's consent to the application of the property's involved in this application <br /> and have been authorized to file on their behalf., and that the f in a ation state e t ar true and correct. <br /> Signature: Date: <br /> Print Name: <br /> Date: <br /> Print Name: <br /> Signature: <br /> Print Name: <br /> signature: Date: <br /> Signature: Date' <br /> Print Name: <br /> DAM Name: <br /> Signature: Date: <br /> FADEVSVOPlanning Apptication Formsweriance:doc.(Revised 8-18-04) Page 6 of 7 <br />