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USE PERM, 11 T r.. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> gg <br /> INd <br /> W"OR MW <br /> A,LITHO,RlZATlON.:SIGIVATURES , af �� ' <br /> <�W r 3e EY �r..'a+R , ',,�"°'' -F`s�.o � .. ,.�, 4. �._. �r <br /> *THE, NNER 0#THE PROP Rr1�ORGAN AUTHORIZED`AOENT MAYS FIL AN'ApPCICAFION. . <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): i <br /> or Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> officer) 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 <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 /> nn <br /> FNa o /'7 7 l Signature: Ado- Date: :l 3 <br /> i <br /> Signature: Date: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> x <br /> r , <br /> i <br /> r <br />