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APPLICATION - HOME OCCUPATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �g BL ADPL. NO: BL 0 0 0 6 9 <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF HE PROPERTY OR AN AUTHORIZE©AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to Jefend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project, <br /> I shall not employ any person other than a member of the resident family who resides on the premises. <br /> I,further,certify under penalty of perjury that I am (check one): <br /> Legal property owner(owiier includes partner, trustee, trustor, or corporate officer)of the property(s)involved in this <br /> application, or <br /> F1 Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been aUthori ed to fie on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: &, a> _ % Signature: Date:� <br /> Print Name: Signature: t3ate' <br /> STAFF USE ONLY <br /> UdP Designation: L_ Zoning: 11 �~ APN: <br /> DEPARTMENT APPROVED ED DENIED , DATE <br /> Development Services t Planner Name. /7- <br /> Building <br /> Building inspection <br /> F <br /> Iir`fr�'4W hl of i'C3iv <br /> Public Works Department <br /> License Approved For: <br /> Accepted as Complete: Date: <br /> F:W*..VSVC\N9nndng ApplicsWn Forms`Honie 0(x-up3t�,ooc. Page 4 of 4 <br /> (Rens,-d 11-16-M) <br />