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APPLICATION SPECIAL PURPOSE PLAN <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES' <br /> ONLY THF OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> O Legal property owner(owner Includes partner,trustee, trustor,or corporate officer)of the property(s)Involved in this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved in this application and <br /> have been authorized to rile on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: 2 L Signature: J�L.�,.V.- ,_D l,it <br /> _ Data:1 2S Z <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> { <br /> 4 <br />