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USE PERMI i <br /> SANJDAQUiN COUNTY(' -UMUNITYDEVELOPMENT DEPARTMEN <br /> O <br /> ' � OHC .:TH YVHFJT-OF�TNEPRO. , O ,AOS111TEl/i1�A CATiO <br /> 44 11 the Owner/Agent agree, to defend,Indemnify,and hold harmless the County and Its agents, <br /> officers and employees from any claim,action or proceeding against the Owner/Agent's project <br /> I, further, certify under penalty of perjury that 1 am(check one): <br /> o Legal property owner(owner Includes partner, trustee, trustor, or corporate <br /> L officer) of the property(s)Involved in this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the <br /> r j property's Involved in this application and have been authorized to rile on their <br /> 1 behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: Signature; <br /> ' �ZS <br /> Print Name: <br /> 5lgnature: Date. <br /> Print Name: Signature; <br /> PrintName: Date: <br /> Signature; <br /> � <br /> Print Name: Signature; Date: <br /> Date: <br /> 4 �I. <br /> E <br />