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APPLdCA TION <br /> �A�ORoUBDV15dQNSAN JpAQU1N COUNTYCOMDAPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHOR1ZEb AGENT MAY FILE AN APPL <br /> 1, the OwnerAgent agree, defend,in [CATION. <br /> and hold harmless the Counryand Its agents,officers and employees from any claim,action or <br /> a <br /> Proceeding against the Ownn er/Agents protect. <br /> 1,further, certify under penalty ofpertury that lam(check one): <br /> o Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of thero ert s in <br /> this application,or <br /> Volved in <br /> P p Y() <br /> o Legal agent(attach proof Of the owner's consent to the application of theproperty's ' <br /> ro ert sInvolved in this app!lcatlon and <br /> have been authorized to file on theirbehalf.,and that the foregoing application state tints are true and correct. <br /> Print Name: K (4Z .. <br /> Signature: <br /> Print Name: pate; (�t� <br /> Signature: <br /> Print Name: Date: <br /> Signature: �—` <br /> Print Name: Date: <br /> Signature: <br /> Print Name: pate: <br /> Signature: <br /> E pate: <br /> I <br /> I <br />