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USE PERMIT <br /> SAN JOAQUlN COUNTY COMMUM.Y DEVELOPMENT DEPARTMENT <br /> n ;. <br /> AUTHORIZATION SIGNATURES r <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ( 1, the OwnedAgent agree, to defend, indemnify, and hold harmless the County and its agents, <br /> officers and employees from any claim, action or proceeding against the OwnerJAgent's project. <br /> t <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> d <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> 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 /> property's involved in this application and have been authorized to file on their <br /> behalf_, and that the foregoing application statements are true and correct. <br /> Print Name: r") — Signature: : �' / Date: <br /> Print Name: I tyi Cc r f 71a A t c"i C- SignatuDate: - - <br /> Print Name: _ Signature: Date: <br /> Print Name: _ Signature: __ Date: <br /> Print Name: Signature. — Date: <br /> t <br />