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kJ <br /> Y <br /> USE PERMIT <br /> SAN JOAQUIN.COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- - <br /> Q3L'9 at, s �.➢' "K. s°`",k _ -a;_ .,, Ali' i <br /> s v: <br /> VIA <br /> � s <br /> ;' . . .. ��;� .,_. OF, <br /> T � OnI ;:-the Owner df-the.Pro ert or an Authorrzed A enf-Ma dile an:;A lrcatrorr �r Cali g <br /> i <br /> 1, the OwnerlAgent,agree to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project <br /> 3 <br /> 1 further certify,under penalty of perjury, that 1 am(check one): <br /> Legal.property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s) <br /> involved in this application,or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to rile on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> Print Name: John Eagal Signature: NQ,, Dafe: " <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> 3` <br /> UPAPP FORM REV.B-I S-02(IHDJ 5 <br />