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.`` E.ADJUSTMENT <br /> .� ,.... � L�TLlN _ <br /> SANJOAOW COUNTYCt)MMIJNfrYAEVSL <br /> OPMeNr DEPARTM <br /> M1`��t{i►1rRI1�linlR/ <br /> ' f 1+1A1 lSC.i <br /> s 4 r v a �i i c* id $pYfi � <br /> r. r � 13 - r'a <br /> ,�y ,,, i <br /> ., ...•< ... ... ,_.. YiNk'i!TFfd:Y�4VN 1�?1 'p00 <br /> officers and employees ftm any claim,action or <br /> 1,the owmedAgwd agree,to defend,lndemnlry,and hold harmless the County <br /> and Its agents, <br /> pmeeeding against the owm WAgWWS ProJeot <br /> r,further, cerdy under penaW Of P@durY that l am(checlt ane): <br /> Legal property owner(owner bmiudes pwVw,trustee,trustor,or co►poree olhcer)of the property(3s)lmrofvejIn <br /> s <br /> application,or <br /> Y\ agent aftech proof of the owners consent to the aPPII"don of the proper"lnvafved 1n this appllcatlo <br /> O Legal ag { aro&w and oonwt, i <br /> been muMorfzed to Me on their behalf.,and that the 1n9 aPPll or atatemetrts i <br /> � Date: <br /> {��p Signature: <br /> Print Name: �' � - <br /> 4 Print Nam®: <br /> �s.rc. Sfgnatur+e: Date: <br /> Print Name: <br /> Signature: Date: <br /> P�lnt Name: <br /> Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> I <br /> 1 <br /> f <br /> I <br /> 1943 M.1PlLV1W f�nry 1,1tY9 �� <br /> t <br /> 1 <br />