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. ., USE PRRM17 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMEN7 <br /> FILE NUMBER. UP <br /> 110 <br /> ii IRR <br /> I <br /> i, the OwneNAgent,agree to defend,lndemnify,and hold harmless the County and Its agents,officers and employees from any clalm, <br /> I action orproceeding against the Owner/Agent`s project. <br /> j l further certify,under penalty of perjury,that I am(check one): <br /> C7 Legal property owner(owner includes partner, trustee,grantor,or corporate officer)of the property(s) <br /> Involved In this application, or <br /> L7 Legal agent(attach proof of the owner's consent to the application of the property's Involved In this <br /> application and have been authorized to file on theirbehalf.,and that the foregoing application statements <br /> are true and correct <br /> Print Name: Mitchell D . Cosentino Signature: Date:- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: - Signatures Date: <br /> Print Name: $ignature: .:.. Date: <br /> r <br /> t <br /> uPAPP FORM REV.B-r5"D2(IHN - - <br />