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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- - <br /> ( t#... <br /> WIZ4MV, /GNATURES, r„ <br /> :the en Application' <br /> Oni t� zMFil }� <br /> z. <br /> I, 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 /> I further certify,un-deer penalty of perjury,that I am(check one): <br /> t� Legal property owner(owner Includes partner, trustee,grantor,or corporate officer)of the property(s) <br /> Involved In this application,or <br /> O 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 file on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature Date: <br /> a <br /> I Print Name: Signature: Date: <br /> t <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date: <br /> UPAPP FORM REV.6•16-02(IND) 5 <br />