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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,i•.L3 u^_:5`'Yier2s. > +x - .^ a - .> a. t.w: :,Nc�n. i♦...tl�Ga.S i.LCa ,..a'L..'St�s_. �,.�'cC aa.nx+3i+i� ti <br /> "' ,,. .� ;AUTHORI ZAJTION SIGNATURES. ,R �� <br /> 1'r11'111'1'111--,1'-. . OWNER OF THE PROPERTY; Lrr T?e? Y+,artr�f+ )R <br /> * -. 1 . n1 ONLY THEOR AN AUTHORIZED AGENT MAY FILE AN APPUCATION <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, <br /> officers and employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that 1 am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> officer) 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 <br /> property's involved in this application and have been authorized to file on their <br /> behalf., and that the foregoing application statements are true and correct. <br /> Print Name: TqM G 5 a,*1)U Q(-A\I Y Signature: Date-;2 <br /> Print Name: �AI R Ci A A• .YUNL A V} Signature: CA Date:a'21 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />