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SU/MS (MH) <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> t,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> action or proceeding against the OwneNAgent's project. <br /> I, further, certify underpenalty of perjury that I am(check one): <br /> ❑ Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s) <br /> nvolved in this application, or <br /> Legal 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 behalo <br /> and that the foregoing application statements are true and correct. <br /> A(50 Print Name: ' A LA1v0 06 Signature: D"" Date:��Sf <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> PM 9944Wdm1n\m1sc\MH-Subd1v1sion SU-MS Form-19944.doc -4- <br />