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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY,COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORtZAT.lOI SIGNATURES <br /> E�M.1l;7HE.C1W11EER 0 SHE PROPERTIF<OR APt lttiTHORIZED AGENT-MAYFIt IM'�IN:APPLICATI©1� <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 /> ❑ Legal agent (attach proof of the ownee's consent to the application of the property's <br /> involved in this application and have been authorized to fele on their behalf., and that <br /> the foregoing application statements are true and correct. <br /> Print Name: .J JN IG H Signature: aC r3 H,4-4 1111 - )W et 44 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -5- <br />