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USE PERMIT fi <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> aM � AUTH.4RIZATION" <br /> .:V'•n,.. ..Iv J 1Y < .:bX�... )f Ela Qt <br /> "�",_..+1 c r A9, •J t eke dA. x'r +.red ,r, 'r`r ¢+"ras,r ha'�vu:^,ate 't'r,r" _`A. <br /> ONLY.THE. <br /> OWNER OFTHE"PROPERT-Oi?ANAUTHOPJZEDAGENTMAY.:FILE'AN:i4PPUCA770N,, <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 /> } <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 application statements are true and correct. <br /> Print Name: Signature: Date.- <br /> Print <br /> ate:Print Name: Signature: Date: <br /> ij <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> r <br /> r• <br /> -_ .s <br />