Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> is <br /> AUTHORIZATION SIGNATURES .: <br /> I <br /> ONLY THE 04YNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent 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 projecL <br /> 1,further, certify under penalty of perjury that 1 am(check one): <br /> I <br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> I <br /> 0 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 rile on their behalf.,and that the foregoing application statements are true and correct. <br /> I' <br /> Print Name: / Date:gmature9f/JJIII/ D <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date; <br /> Print Name: :'Signature: Date: <br /> Print Name: ;Signature: Date; <br /> �r <br />