Laserfiche WebLink
,OT LINE ADJUSTMENT <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 77 <br /> Au g001?r4710N SIGIYATIJR S <br /> i <br /> OIILY7Ii C4MNf7tGFTN i�RQ RrY1!ORANAUrHORIZr=G.AGENT:MAYFILEIW APPLICATION. <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees!i om any claim,action or <br /> proceeding against time Owner/Agent's project <br /> 1,further, certify under penalty of perjury that 1 am(check one): <br /> O Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved in this <br /> application,or <br /> Q Legal agent(attach proof of the owners consent to the application of the property's Involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: ,� WL,e5 ASignature: Date:59B-d'A <br /> Print Name: _ . Signature: '(�' Date6 � 2' <br /> Print Name: Signatu Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> I MAMPkLAWFGbo=y1,19N <br /> —4— <br />