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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> E- <br /> .11,6tan-Appfication <br /> 1, the OwneNAgent,agree to defend,Indemnity,and hold harmless the County and Its agents,officers and employees from any claim, <br /> action or proceeding against the OwnerlAgent's project <br /> 1 further certify, under penalty of perjury, that I am(check one): <br /> O Legal property owner(owner Includes partner, trustee,grantor,or corporate officer)of the property(s) <br /> Involved In this application,or <br /> XLegal agent(attach proof of the owner's consent to the application of the property's Involved In this <br /> application and have been authorized to file on their behalf.,and that the foregoing application statements <br /> are We and correct. <br /> Print Name: 21-661 I O�/J JZ Signature: ( Date: <br /> Print Name: Signature: .O Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> IIPAPPFORMREV 4ib0 WO) 5 <br />