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r; " - _. .. ... . ._ 1 <br /> LO ADJUSTMENT <br /> . � b. <br /> F i <br /> SAN JOAgUlN COUNTY COMMUNITY OLr-VE Mt:NT DEPARTMENT <br /> IIurwRlZAT1ON 5KaNATiJRES <br /> ONZY-THE OYVNER OF..Yl� PROPERTyOR AN AUTHGRlZED AGENT MAYF�1:tx 41+[ i4PP[c1CA CIDAt claJm,action or <br /> L, from any <br /> ` and hold harmless the County and its agents,0Mcars and employees <br /> 1,the Owner/Agent agree,'to defend,Indemnify, <br /> . proceeding against the Owner/Agent's prof ect <br /> ury that I am(check one): s Involved in this <br /> f,further, certify under penalty of P� trustor,or corporate officer)of the property() <br /> p Legal property owner(owner Includes partner,trustee, <br /> application,or s Involved in this application and have <br /> attach proof of the owner's consent to the applicationppl of the property' <br /> p Legal agent( oIn a lrcatfon statements are true and cor►ecL <br /> been authorized to file on their behalf.,and that the foreg g pp <br /> { <br /> Date: D <br /> Signature: <br /> Print Name: ti„ <br /> _ A L�� � � � L-� Signature: Date: <br /> Print Name: ` Date: 1/ 2[ OZ <br /> 4� Signature: <br /> t iq`�[Y10 11� 1 Date: <br /> Print Name: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> .G Print Name: <br /> E <br /> F . <br /> it , <br />