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- = APPLICATION ' USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,i �5.. ' S 3#a 5 5 5 ,,, , ] < <br /> .:]M1 SKS 3�;?a..75�.?i 5?SS St`#55 #..}5�# ]€};t....�l35?#S< <] .'t :*'::`:# 5 ?.. <br /> 1' w <br /> :.. SS. .:S 5 ].#fa€ai5:�s.£37533355# AUTHORIZATION SIGNATURES <br /> tttt $ <br /> ...> S$S �i R......Ws5t <br /> :;.....: € �#1#5;f.s. ONLY THE OWNER OF THE PROPERTY OR AN AUTFIORIZED AGENT MAY FILE AN APPLICATION. .,.,..'t ' '?.;' >> ...::,::... <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project <br /> I, further, certify under penalty of perjury that I am (check one): <br /> o Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> 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 property's <br /> involved in this application and have been authorized to file on their behalf., and that the <br /> foregoing application statements are true and correct <br /> Print Name: 9r,1 0 /W Me aley Signature: "'f Date: /Q <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />