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Uec--30-97 11 . 22A ADVANC-0 UESIGN GROUP (209 577-0872 <br /> P_ 05 <br /> APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ...;�. ;'•ii{�1tI'!:i�li a-iii(%:3;inti ii::'it!'si':ity:li�iC3;yi2?il� 4iilisi'r.°.?,3i i'?r.f 3:. �.:�±- <br /> • ��Ii�)luti !S ... y. �.uEZl..,.... <br /> yiI I AUTHORIZATION SIGNATURES: <br /> t!.it:yj}. y{ 5 <br /> ' .. ,.�., f 3 y ! <br /> i.ONLY 7FiE OWNER OP THE PROPERTY OR AN AUTHORtM AGENT MAY FILE AN <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers arid <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> �( Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> 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 property's <br /> Involved in this application and have been authorized to file on their behalf., and that the <br /> foregoing application statements are true and correct. <br /> Print Name:-�}a Lk- P,4ignaturoi -1// i Il l' r - Date' / 1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />