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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 /> ONL Y THE OWNER OF THE PROPERTY ORAN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> i, the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its agents, officers and employees from any claim,action <br /> or proceeding against the OwnerlAgent'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 Nle on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: `�13 qrT ) U90rikECSignature: Date: a . <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 1 <br /> -s- <br />