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I <br /> j; <br /> APPLICATION LOT LINO :` AC <br /> E /.. A�� $ ',HENT i <br /> SAN JQAQUI�I COt1NTY COMMUIl €Y pEVi^l OPMEIV� o£f ARrIVfENr <br /> f ML NUMStk- <br /> I <br /> 1. the Owmer/Agent agree, to defend, Indermiify, and hold har <br /> employees from arty claim, action br proceeding against the 0 refer/A tent�County and its agertts, fl#ff a' <br /> 9 project. y <br /> nd <br /> Ji Further;certify under penalty of perjury that I am (check ane): <br /> legal Property owner(owner Includes partner,trustee,trustor; or corporate afflcer of the <br /> Involved In-this application, or <br /> property(s)- <br /> A <br /> i <br /> C3 Legal agent (attach proof of the owner's consent to the application of the pro rt y s Involved <br /> application and have been authorized to file on their behalf., and that the foregoi g'applfcanstat mems <br /> are true and correct, <br /> Print Name: DAYILLA LODI FAMII'YgO ERSHIP <br /> Print Name: BETTY DA V I L LA Date; <br /> It 's General Partner Signature: p( _� � Date; — /11_Zv_ <br /> Print Name; Signature: - . <br /> .E PrintName: <br /> TONY DAYILLA Date: <br /> It s Genera ar nex Signature. Date;`l_I�` ��. <br /> Print Name <br /> ; Signature: <br /> j Date:. € <br /> ' a <br /> i <br /> i <br /> i <br /> i <br /> r <br /> ti <br /> - s <br /> 4 <br /> i <br /> 1 F:0EVSVMPIenn1n9`AppikouonPormsh Page 5 4f 7 <br />