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t_ <br /> APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> G <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,indemnify, and hold harmless the County and its agents, officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that t am(check one): <br /> O Legal property owner(owner includes partner, trustee,trustor, or corporate officer)of the property(s)Involved in this <br /> application, or <br /> i <br /> O ; Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf,and that the foregoing application statements are true and correct. <br /> Print Name: p ri Signature: Date: <br /> Print Name: Signature: _ S Date: `7 ry- `l_ <br /> i 1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i� <br /> Print Name: Signature: Date: <br /> ,7 <br /> i <br /> 1 <br /> i <br /> i <br />