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a�. <br /> APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT i <br /> $t AUTHORIZATION SiGNATIlRES :'> `,'....:;.' ` f # <br /> Ys.x,..,,.. <br /> 5- <br /> ....<:::. i <br /> E}NF_Y THE OWl1EEfi of THE PROPERTY OR AN AlJTHORIZED AGSM"MAY FILE AN APPLICATION,; •.;..},s>.,'# }}j +.:f. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. t <br /> I, further, certify under penalty of perjury that I am (check one): <br /> f <br /> a Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> 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 property's <br /> linvolved.in this application and have been authorized to•file on ttieir;behalf., and that the <br /> foregoing application statements are true and correct. <br /> Print Name: t7ni Kl+gNoFEL Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature, Date.• <br /> jPrint Name: Signature• s Date: <br /> i <br /> _o_ <br />