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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> F <br /> ORgent,agree to defend,indemnify,and hold harmless the County and its agents, officers and employees from any claim, <br /> eding against the Owner/Agent's project <br /> fy, 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) <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 oeen authorized to file on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> Print Name: EUVARD L. SELIG%N Signatu Dater/Z3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> UP�RP FORN REV bISO}(IMO) <br /> 5 <br />