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APPLICATION - USE PERM-1T.. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTN0... TION SIGN,ATUfi�ES'' <br /> ONL 'FHL OV{INEROF.73 E FROPLRTY;Oft PNAiJTNORfZED.ACiENT NtAI!FTI L:is(k Iirmr., QlT1CTf; . <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 /> d <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> X` -L`egal,property owner-(owner incl-udes-partner, trustee, trustor, or-corporate-officer) <br /> of the property(s) involved in this application, or <br /> ❑ Legal agent (attach proof of the own'er'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 <br /> the foregoing application statements are true and correct. <br /> Print Name: Signature: Date; <br /> Print!Name: Signature: Date: ' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> l <br /> s <br /> v , <br /> �i <br /> -'1 <br />