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v <br /> AJr , <br /> APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPEH'�Y OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,Indemnify,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 /> 1, 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 this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to rile on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: � 0.r-r` Mo-r7V r d <br /> I Signature: Date: Z7 Q <br /> Print Name: I�p'q Mq.,��l II <br /> Signature: G� Date:3 Z7 G 2 <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> 5- <br />