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APPLICAI,wJN - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION'SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 /> I, further, certify under penalty of perjury that I am (check one): <br /> ❑ Legal property owner (owner includes partner, trustee, trustor, or corporate officer) <br /> of the property(s) involved in this application, or <br /> 13 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 <br /> the foregoing application statements are true and correct. <br /> Print Name: please see attached Signature: Date: <br /> au oriza ion form <br /> Print Name: n Signature: Date: <br /> Print Na rry ��Ili G5.D Signature: h �/���U" /4'�LC/'L Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />