Laserfiche WebLink
. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> At1TFtORIZATIOht:SfONi4TURPzS .'..;: <br /> "-: 77777777777 <br /> ONLY7HE.OWNEl�bF>THEPfZOft �'1!:l5RAWA> f�'1'EiOR '°`a MAYFIL AN-,'A KATION <br /> 1,the OwnerlAgent agree,to defend.Indemnity,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> i,further, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property{s)Involved in <br /> this application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and I <br /> correct. <br /> Print Name: _DnL « �� r— Signature: 5 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> t <br /> tl <br /> E <br /> f <br /> -5- <br /> i <br />