Laserfiche WebLink
SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> bNLYTH dVI/NE1 .7FiI;I bI� R71r# I�(z WMAY—.RIL&WAPPLICA710N ........ �......? �:;>.- ....,:s <br /> I,the Owner/Agent agree,to defend,lndemnlfy,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> Orr proceeding against the OwnerlAgent's Project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> �N. <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)involved In <br /> " this application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: Signature: Date: <br /> Print Name: Ti4 /li: c !cam.-_ Signature: � r,.L Date: S��?—p 7 <br /> s - <br /> Print Name:�/'4`11�,5._ ',�,9VCs � -_ � Signature: .� Date: `�i7- 7 <br /> Print Name: Signature: Date: <br /> Print Name: II Signature: Date: <br /> y <br /> i <br /> I <br /> i <br /> I <br /> ij <br /> I� <br /> .I <br />