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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- <br /> "AUTFJ RIZAi7_0_1S.'-NATURES <br /> Oniy the Owner of the Property or an Authorized Agent Ma;%File an Applica?ior, <br /> 1, the Owner/Agent,agree to defend, indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project. <br /> I further certify, under penalty of perjury, that f am(check one): <br /> Legal property owner(owner includes partner, trustee,grantor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> , <br /> O 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 rile on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> N �r <br /> Print Name: _R6S)=L.q 4- ANI6n7C-r? Signature: Date: <br /> Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: _ Signature: _ Date: <br /> Print Name: Signature: Date: <br /> r <br />