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S <br /> _ JT. LINT ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUN17Y'DEVELOPMENT DEPARTMENT <br /> ,LL ' <br /> At1ri <br /> r1R}2AT740N SibINI1'�JRE"3 <br /> NL-V.THff*WMWD,*.THE`P�ORAMA[l7F1 phabAQEN7"MJIYI�ILEAN:�lPAilCJff10N. <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and!ts agents,officers and employees from any claim,action or <br /> proceeding against the OwnedAgenfa pmject <br /> 1,further, cerbW under penalty of ped wy that I am(check one), <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the pmperty(s)Involved In this <br /> application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the propert)'s Involved In this application and have <br /> been authorhed to tele on their behalf,and that the foregoing application statements ars true and correct. <br /> 41- <br /> Print Name: Signature:nature: Date: <br /> /' Si <br /> Print Name: Signature: 4� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> C <br /> P <br /> iM AMPA AW Fdrivy 1.109 , <br /> -4- <br /> E <br /> e <br />