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A <br /> APPLICATION SITE APPROVAL <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . ............ 1:1 X,' <br /> IN, <br /> .......... <br /> ............ <br /> ........... .... .......... <br /> ............................. -A <br /> .................. <br /> ...................... <br /> ................ <br /> ............. ......... <br /> 'RAO." <br /> .......... ........ <br /> ........... <br /> M": A.M.-A <br /> AAW: MA <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> El Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> E3 Legal agent(attach proof of the owner's consent to the application) of the owner of the property(s) <br /> involved in this application and have been authorized to file on their behalf, and that the foregoing <br /> application statements are true and correct to the best of my knowledge and belief, <br /> JI <br /> Print Name: S/Z U1g7 Signature: Date: <br /> Print Name., Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />