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UNE�AD <br /> JUSTMENT <br /> SAN JQAQUIN COUNTY COMMU1WTy DEbFLOPME11fT pEp/IRTNFNr <br /> ,,-7777 <br /> fYOIV.SIbIVA ,' <br /> ` •,.;CJ�IiIL�". `. CJWHl9�'OF7�P' T'Y�ORIW�ILIT/{O�tfZ�ilfimlfy'MAY.J9bE'AN Af�PY1C'�iTJCi11� <br /> I,the owner/Agwd agro%to"W4, lN,and hold harmless the County and its ' . <br /> g against the Ownw/Ilgwrt's project agwrts,otffce►s and employees from any claim,actlor!or <br /> Proceedin1,further, cerdly under penalty of pwiirry that l am{check one): <br /> O Logal Property owner{owner Includes partner,6usreo,6istor,or corporate o <br /> applk atto k or tflcsa)of the pnoperty(s)Involved 1n this <br /> O Legal agent(attach pYroof or the ownw it consent to Lha appliesdon of the <br /> bQwr 4Udwrked to iffe on their b~,and that the olnS aPW►retlwr statepr�Pwant lace nvoIn this application and have <br /> EmerrLe are true and correct <br /> Print Name: MICHAEL A. BARTON <br /> Signature: Date: 7// <br /> ! oI <br /> Print Name: EDWARD F. DILLMAN <br /> Signature: <br /> Print Name: ' w*��Dato��l <br /> Signature: <br /> Print Name: Date. <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Date: <br /> I <br /> -4- <br /> Y <br />