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a°" , �� APPLICATION — SPECIAL PURPOSE PLAN <br /> a " y< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �.�'.. �p FILE NUMBER: SP- - <br /> �/FOFH <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION_ II <br /> Applicants <br /> I, the L Ipl114 t-agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from the OwaerfAge4U&project. <br /> Applicant's <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ® *Legal property owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s) involved in <br /> this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: Pastor Bill Cummins Signature: �,, / Date: /24;z Y/y/a !/ <br /> Print Name: Rev. Monsignor Richard J. Ryan Signature: (/ WAC d.Vl Date: J 12 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> * Applicants obviously do not own Lower Sacramento Road but they are making the application <br /> for the Amendment. <br /> RmEvsvmPlanning Application FormslSpecial Purpose Plan.doc. Page 5 of 6 <br /> (Revised 5-11-09) <br />