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SU/MS (MH) <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent 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 /> 1, further, certify under penalty of perjury that I am(check one): <br /> ❑ Legal property owner(owner includes partner,trustee, trustor, 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 been authorized to file on their behalf) <br /> and that the foregoing application statements are true and correct. n�/ <br /> Print Name: David Sargent Signature: 9 .5,- Date: 512118 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FWountain HouselApplicatlon Forms\MH-Subdivision SU-MS Form-MASTER.doc -4. <br />