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.°"=��� APPLICATION — USE PERMIT <br /> � � SAN JOAQUIN COUNTY GOMMUNrtY DEVELOPMENT DEPARTMENT <br /> _ FILE NUMBER: UP- <br /> OtMr <br /> DesUba an Ilatm of hlabrlcal or amhamt Iml Into t oniha a mabtlee er e4uctur a <br /> e <br /> Deawlbe a nalb m ott-vib sou M o or Nbratlen o baawa nolea hea vl rmnt eNe. ; <br /> -}' L -f'�-a L <br /> DaecKbe an onella or oR- It0 murme o1 II ht or late a rMn le[II htl or eaMCNve mataAata usetl <br /> DeacnM an on-aNe er eR-alta souru of eEor a rbulWral wastac <br /> C <br /> Dasc`t161s I nt oI ae Ia Yat will M1e wusatl Na a act o umbam of b houa Ib <br /> \v L <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, tc defend, indamnly, and hold harmless the County antl Its agents, oTflcers and <br /> employees from any claim,action or proceeding against the County adsing fmm the Owner/Agent's protect. <br /> I,furthaq cartiry under penally of perjury that I am (check one): <br /> � Legal properly owner(owner inclutles partner,trustee,trDsloq or corporate o�car)oT the property(s) <br /> ��involvatl in this application, or <br /> +L� Lagel again(attach proof of the owner's consent to the applicat(on of the property's Involved in this <br /> application and have been authodzad to fila on their behalf.. antl he foregoing eppliragon statements <br /> era true and carred. <br /> Pmt Nama: /!//Pie /fOJ4n/e./- slgnaturo: Dab: <br /> Prtn[Name: Slgnaturo: Deb: <br /> Prinl Nama: 31gnaWm: Delo: <br /> Prim Nama: Signature: Delo: <br /> Pnnl Nama: Si9nalura: Data: <br /> rwavavcmm�m.,e ronaa�w�F�.....lu..n.,...�.taewwoa-oanot Paga5or9 <br />