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-if OTT LINE aDJUSTMENTI <br /> SAN JOA OWNCOUNT�htMl1NRY DEVELOPMENT DEPAlZT E1Vf ' <br /> :, .... <br /> µ-. a h N ., � - x �-.)r �s 3 a5 f, � - .V/ l --w- ■ - /�` '�'��j`�., y:'+n ��..�:,�'`"' ;4s:'-y. <br /> -�'��'' {�` �` '`H,.t•n�:-�'" �7Nb'r7�1�'C�I+VN �7. : �f�AP�TYrO�Jf��9[�'FffORf��tl�tiC�t�YY'A .. . <br /> hold harmless the County and its agentsr officers and employees from any claim, <br /> action or <br /> proceeding against Me Owner/Ag •and <br /> enes Pr e'er <br /> !,further, certify under penalty of pedJury Mat'am(check one): <br /> O Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)lnvoheed In this <br /> appffcada%or <br /> Q Legal agent(attach proof of fire owners' consent to the application of the pmper4ft involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are tare and correct . <br /> Prfnt Name: �Sfgfrature. <br /> Data. <br /> _ Data: <br /> Print Name: GZ it h Signature: <br /> D <br /> Print Name: <br /> Signature. ata: <br /> Signature: Date. <br /> Prinf Name: <br /> Signature. Date: <br /> Print Mama: <br /> a <br />