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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 OR AN AUTHORIZED AGENT MAYFILE AN APPLICATION. <br /> 77V <br /> ree, to defend,Indemnify,and hold harmless the County and its agents, officers and employees from any claim,act lon <br /> the Owner/Agent's project. <br /> eerr 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 ro erty's Involved in this application and <br /> have been authorized to ale on their behalf.,and that the lore g cation s a nts are true and correct, <br /> Print Name: = / J Signature: <br /> ti Date <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br />