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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .A FILE NUMBER: UP- <br /> MINN"AUTHORIZATION Sly A:� R <br /> Only the Owner of the Properly or an Authorized Agent May File ar9#Appllcatto <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 OwneNAgent's project. <br /> I further certify,under penalty of perjury,that I 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 /> G 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 We on their behalf,and that the foregoing application statements <br /> are true)and correct. ,. q 1 / f <br /> Print Name: 0101'.) I f-)J IPc Cln l Al I Signature: IL�rA.0 ,l,8/'K,u/lti/� Date:/O <br /> Print Name: Qpd LA 1 U J f 5 C k t IJ I Signature: �QQn� /r d*]wq+i, Date:ld <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> UPNVG FOFMXEY.6fS0IIM01 <br /> 5 <br />