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-YM <br /> ` - APPLICATION ,SPECIAL PURPOSE PLAN <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �' ' I I,, a'I '.: I h..-'ill I -.'�:; � II I,,i , p! ! , �I I <br /> �AUTNORIZATIONIO <br /> 5/VNA/{/![$SI <br /> ONLYTNE OWNER.OF THE PROPERTY OR AN AUTHORIZED AGENT NAYFIL 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 1 am(check one): <br /> O Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the properiy(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 /> f; y have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: j / ir.JFL.tr Signature: V, <br /> Date: <br /> Print Name: Signature: <br /> Data: _ <br /> Print Name: Signature: Date: <br /> Print Name: Slgnature: Date: <br /> Print Name: Signature: Date: -- <br /> 1 <br /> i <br /> . I <br /> - �,^T— x - .�-.._+.-.yr .—_..1'. ., — ��Y��x+-'6rt-�TrtFr` K���tx.��l--'-.r�'�,.-:. _ — -act"—%- ,Pza -3rtrti'•'- <br /> , t <br /> t,t f;, SII E a t ., I.t.3. • I r i' •.:. - <br /> ! <br /> 3 <br /> _r- I <br />