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Lo LINE ADJUSTMENT <br /> SANJpAQUINGOUNTYCOMMUNITYDEVELOPMENTDEPAR?MENT <br /> ` Al1TNORJ2u}7ON 3rf1Nr4'�Ll1tE'S , <br /> ONLY7H GWNti'0>#.T7i pR1b <br /> :` E 1lfT?'t?F7AAFACl7'�IORlDj41'dENIMAYf�II.L�IW APPIlCA7bN <br /> 1,the OwnedAgent agree,to defend,lndenrMty,and hold harmless the County and its agents,officers and employees V <br /> proceoding against the Owner/Agenes project P i^ many claim,action or <br /> 4 further, certlljr under penalty of perjury that 1 am(check one): <br /> Legal ProPenY owner(owner Includes partner,trustee,trustor,or co <br /> appllcadon,or corporate officer)of the property(s)irrvolved In this <br /> O Legal agent(attach proot of the ownerW consent to the application of the propWWx Involved in this application and have <br /> been authorised to Elle on tlrelr behalf.,and that the foregoing application statements are true and correct <br /> Print Name: Signature: <br /> Date:Co <br /> s Print Name: Signature. <br /> Date: <br /> Print Name: jz;�M„,.,r Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: <br /> Signature. <br /> Date: <br /> r” <br /> i. <br /> 10:03 AMPALLADO FvOn y 1.19W <br /> -4- <br /> I <br /> 1� <br />