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<br /> APPLICATION USE PERMIT NT
<br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT ....:
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<br /> OR AN AUT}}ORiZED AGENT MAY Fll.e;A[�i APPUCA710Pl.,:=?�-:E>=>.. 3 POP,13 �
<br /> OWNER OF THe PROPS CY
<br /> 1, 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 owners 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 /> �4 mo/v Gu.E� C'eD signature: f Date:
<br /> Print Name: l
<br /> Print Name•
<br /> rj v1A u R.R(--W signature: Date'
<br /> Print Name: IJ R I tke ufc.R O Signature: Date•
<br /> Print Name: FSTHM_ G qf—kRq'r-V-0-- Signature:_ Date:
<br /> Date:
<br /> Print Name: signatu
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