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USE PERMIT <br /> SAN JOAQUiN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ° ? "m�c.l,-i",'��T.,��+,e�+�ry�ar.�.xt. A ,tHUT/IO[lI, r / p®ac+ `►/{ l�pCN�` <br /> m7�,..F.n.,,xr. '�r.�ONLYTNEOWNEROF..TNEPROPER7Y.:0 AN:A ORIZEDAGENTMAYFILEA wAPIPUCA170N; <br /> 1, the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents, <br /> officers and 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 /> Legal property owner(owner includes partner,trustee, trustor,or corporate <br /> officer)of the property(s)involved in this application, or <br /> o Legal agent(attach proof of the owner's consent to the application of the <br /> property's involved in this application and have been authorized to file on their <br /> behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: SAmre-S R DVI LAZY Signature: <br /> Print Name: A'SRICi a A.1�_.�N4 Signature., Date:'y.1r-__,� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />