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r U "} - U USE PERMI <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,;����_ ;� ��� �,� � ',�~�� � - �. �- 'A U7" ORlZA T► N SIGNA 11F`2E �$ <br /> e <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 I am (check one): <br /> s <br /> a Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> officer) of the property(s) involved in this application, or <br /> ,x 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 /> i <br /> behalf., and that the foregoing application statements are true and correct. <br /> Print Name: w���`� Signatur Date: _ <br /> A4 144MM5.iW 0-1 <br /> Print Name: Si re: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> r <br /> 9 <br /> 1 <br /> i <br />