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K <br /> fSAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUT1'IOFtlZA.T N'slciniAivals...-.. <br /> -... + e - est +aC •:y.r+�•rr S w - t}r `"4yy ' <br /> r .•''':-ONLY�YMg:OINNEaOF'1•H�.pROPERTYOF7AN'AU7F#ORIZEt7 AOENTMAYFILEAN�J1PPt1CAl'ION. <br /> armless the County and Its agents,officers and employees from any claim,action <br /> I,the owner/Agent agree,to defend,Indemnify,and hold h <br /> or proceeding against the Owner/Agent's project. <br /> I,further, certify under penalty or perjury that I am(check one): <br /> I <br /> fi <br /> S legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)involved in <br /> thisapplication.or <br /> El Legal agent(attach proal of the owner's consent to the application of the property's Involved In this appllcatlon <br />" and have been authorised to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> Signature: �' Date: G'3 <br /> Print Name: 2 <br /> Print Name: MORD '�1. ~�� � Signature: / �+ �� <br /> - <br /> Date: _3 <br /> ALD IVIA KOZ Signature: Date: 9 a <br /> Print Name: {/ <br /> Print Name: Signat e• Date: <br /> i Signature: <br /> Print Name: <br /> Date: <br />'a <br />.f <br /> i <br /> a <br /> i.% <br /> �I <br /> f'` I <br /> r; <br /> r, <br /> - <br /> 1a..,�.n� <br /> ri <br /> d. <br /> 7i <br /> -4- <br />