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APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <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 OwnerlAgent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am(check one): <br /> 41 Legal property owner(owner includes partner, trustee,trustor, or corporate officer)of the property(s)Involved In this <br /> application, or <br /> O 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: - 1ArJ Signature: L _ Date: <br /> Print Name: rYl_n•��j �1�j(1.�` _ Signatur . Date: <br /> Print Name: _ Signature: 71 Date: <br /> Print Name: _ Signature: Date: <br /> Print Name: _ Signature: Date: <br /> -s- <br />