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SARI JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTK4ENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE VANER OF THM— PROPERTY OF.AN AUTHORIZER)AGENT�,AY t^;I_i=AN APPLICATION. <br /> the Ownerlk.ent agree, to defend, Indemnify, end hold harmless the County and its agents, officers and <br /> employees',%•om any claim, action or proceeding al-ainst Sae County arising-Irr.om die Gaunter/Agent's proiscf. <br /> I, further, ceitffy under pe-why of perjuy that i Ern (check one).- <br /> Legal <br /> ne):Legal property owneL(owner includes partner;trustee, trvstor, or co porate officer) of the property(s) <br /> involved it this app'ication, or <br /> a Legal agent klwtad-:rn.-oof of the owner's ccivent lo the applice-i n of the propeit's Involved !n this <br /> appilca fon and haves been authari?ed io f'v�of n their behafs., and Uta:.the foregoln�; cpplication statements <br /> are true and correct, <br /> I Pi1ntName: I��!J�� !� D Signetwe: ;jg Date:6, tin <br /> Hn't Name: <br /> A'2�J ��`Si naturo: gate: '711 I <br /> Prlrit Wame: gnat : Date: <br /> Piirit Narra: &gneture: Date: thh' <br /> Print dame: Signature: Date: q <br /> 1 <br /> F.1D6V8"Lerrdr*AWIca#on Formal Page 5 of 7 <br /> W line I v:lust ent CIOs.(R"[FA 05.11-09) <br />