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�0. <br /> AT = U S T tis <br /> APPL�C iQN aM NOR S � BDI I i4N <br /> T.a�-0 - <br /> a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> } AUTH0REZATlCNSIGNAT.1JR <br /> OiVLY.TFIE OWNERaF.T IE'OROPERTY OR H0ZE <br /> AN AUTRI &AG5NTMAY.FILL=AAF APPEI ATION.: <br /> r a <br /> I,the Owner/A ent a ree'to defend'iWe;61y, County agents, pl y <br /> 9 g - ,and hold harmless the Coun and its a ants officers antf em to ees from any claim;action i <br /> or proceeding against the OwneriAgent's project <br /> I,further, certify under Pe ity Of.perjurythat i am(check one}; r <br /> Legal.property owner(owner includes partner,trustee,trustor,or carporate officer)of the property(s)involved in <br /> this application,or ^!3 <br /> - ❑ :,k t Legal agent(attach proof.o_ f the owner's consent to the application of the property's!evolved In this app-11 don <br /> and have been authorized to file on their behalf.,and that the foregoing application'statements are true and . <br /> correct. <br /> ' Print Name: Signature: c�� Dater �/ <br /> Print Name: e "�z-�'e-t- . u f^ Signature: Date: Z <br /> Print Name: , ' <br /> k:: *V �' <br /> E"11` c Signature: ; `Date` <br /> Print Name: /y Signature: Date. t <br /> A- Print Name: x Signature: Date: <br /> r <br /> -71 <br /> x`N t <br /> 't, <br /> C. <br />[ T - <br /> 9^.: - • �): -'f M u .e ;df.�' ..�a-" k <br /> `.r r. .•.-+ ti I . t !1 - - - r •y ..:�'i.. i'o eS".i �,S .�<.�N�... ' <br /> ! . S•,zr M.i.t icd �+da;t _. .s§ <br /> .. .. Y Jnr <br /> r ..t �.Sd "°ar�,.+�'-� .+r^. .^reF+aoru '+.��.• Nr`x - r `i°s * rso36-. <br /> ✓.��':"4 &,SIC ;�. 5f �1 - t :+. y +F '! „x,�..k. i��:.. a,. -s.t;i-y �..k �' �( ;��" _ - � a��.�.� � �.kn^G''_ --.-„ <br /> 8r... •- .. „...:...ems n:w:ac,. ':r.,wr. :..:Y:�. ,. [ <br />