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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> AUTHORIZATION SIGNATURES _ <br /> Only the Owner of the Property or an Authorized Agent May File an Application <br /> 1, the OwnerlAgent,agree to defend, indemnify,and hold harmless the County and its agents, officers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project. <br /> 1 further certify, under penalty of perjury, that I am(check one): <br /> Legal property owner(owner includes partner, trustee, grantor,or corporate officer) of the property(s) <br /> involved in this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf,and that the foregoing application statements <br /> are true and correct. <br /> Print Name: lfyDER `�p�1GNF f2,Ar�+ Signature: L/ Date: V14/6' <br /> t( <br /> Print Name: �4 tR1ItA t— Signature: Date: <br /> Print Name: MANT( % S (A16Pf Signature: Date: �114rok <br /> Print Name: AMRt'rPAL S 'IIWANA Signature: Date: S�tgloy <br /> Print Name: AAL lJA1'taDUR PI(UL� Signature: Date: SIly�o4 <br /> OPAPP FORM REV 845 elHc) 5 <br />