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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN ALITHORfZED AGENT MAY FILE AN APPLICATION. <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 /> 12" Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> Legal agent (attach proof of the owners consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf., and that the foregoing <br /> application statements are true and correct. <br /> Prin[Name:�,q,�r ff�2p �f ,lyii ���sL Signature: _ Date: �J/yr-yam j <br /> Print Name: ecS /A/���,, �q � Signature:9 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> SAN JOAQUIN COUNTY <br /> STOCKTON METROPLOLITAN AIRPORT <br /> 5000 S. Airport Way <br /> Stockton, CA 95206 <br /> PHONE: (209) 465-4700 <br /> E�'Approvet: <br /> ❑ Approved with changes: See Remarks <br /> ❑ Disapproved; See Remarks <br /> Remarks <br /> Date _ 11 _ By <br />