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SUMS(MH) <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY ORAN AUTHORIZED AGENTMAYFILEAN APPLICATION. <br /> 1,Ne OwnenAgent agme,to defend,Indemnity,and hold harmless the County and Its agents,oRlcem and emptoymn hum any claim, <br /> action orproceeding against the OwnerlAgent's project <br /> 1,further certify under penalty of perjury Nat I am(check one): <br /> ❑ Legal Property owner(owner Includes partner mistes,truslnr,or corporate officer)of the pruperfy(s) <br /> Involved In this application,or <br /> W/Legal agent(attach Proof of the ownees consent to the application of the property's involved In this <br /> application and have been suthorhad to file on their behagf <br /> and that the foregoing application statements ars true and correct. 1 <br /> Print Name: L/4J.A Slgnafure: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1Mounlain HmseWppllralbn FormsWd uh IWN SUMSFwm STMRdm A. <br />