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�APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> K }. <br /> 121 <br /> mmw <br /> ::,:,AUTHORIZATION SIGNATURES ......;: <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORUED AGENT MAY FILE AN APPLICATION.:::'.. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents,•officers and <br /> employees from .'any claim, action or.proceeding against the Owner/Agent's project <br /> 1, further,- certify under penalty of perjury that I am'(check one): <br /> y... o Y 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 tfie application'of the p�opeity'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 Nae: � 1\M 10, A A ML, y Slgnature: Date: <br /> m <br /> Print Name: .Signature: Date: <br /> Print Name: ..Signature: �.. .. . ' Date: r <br /> Print Name: ' " ` Signature: ' Date: <br /> Print Name: Signature: Date: <br /> .- ..,,., <br /> Y <br /> f <br /> t <br /> -7_ <br />