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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 PROPERTY ORAN 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!le on their behalf.,and that the foregoing application statements are true and correct. <br /> 41 1i <br /> Print Name: L� C C2U �. 6rI fL+�\ Signature,- ' Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -5- <br />