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'I (--k;OT L1NE ADJUSTMENT <br /> C SAN JOA QUIN COUNTY:.AWUNfT'Y DEVELOPMENT DEPARTMENT <br /> ism <br /> At1TH0171Zf{?10N 81G71i,4711RE$ <br /> .. . " .. .'..,:? `"� ONLY.TFI�OWAIEI .O��PRIOP�ItTYOF7�INAEI.TfiCRiX�bAGF_N7'MAYfifl.1:+AN�/iP.RLfL`JfT1DN.....y �1'x f: `�`` Y _ <br /> 1,the Owner/Agent agree to defend,Indemnify,and hold harmless the county and Its agents,officers and employees from any claim,action or <br /> proceeding against tits Ownergent's project. <br /> 1,further, certify under penalty of perjury that f am(check one): <br /> s <br /> i� <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(aftach proof of the owner's consent to the application otthe property's Involved In this appllcatlon and have <br /> been Iauthorized to file on theirbahalf,and that the foregoing application statements arae true and correct <br /> li EI <br /> Pdnt Name: Anthony !$. Ghio Signature: fate: r <br /> PrrntName: Angelique M. Ghio rl <br /> 5lgnature: ` <br /> Date: .1!-q-o <br /> Print Name., P Signature: Date; <br /> iM <br /> Print Name: Signature: Date: <br /> ;v <br /> Print Name., Signature: Date: <br /> I` <br /> n <br /> i, EI <br /> E. <br /> II <br /> E' <br /> if <br /> i` <br /> I <br /> Et <br /> E, <br /> �I <br /> E. I� <br /> !I <br /> i. <br /> I <br /> E: <br /> E ; <br /> i <br /> E , <br /> E <br /> r <br /> II <br /> ;I <br /> is <br /> E' <br /> !E I <br /> s I <br /> 90:03 AMPA�LAM F.brumy 1,7880 <br /> I <br />