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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP _- <br /> 05 ! " ...:.- .,:: _ `vee` 4, ';^ !�`u•e �;y,gr -. r <br /> b ,a Fl���iA# a�l#fat► <br /> 1,the Owner/Agent,agree to defend,lndemnlfy,and hold harmless the County and Its agents,offlcers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project. <br /> 1 further certlfy,under penalty of pedury,that 1.am(check one): <br /> Legal property owner(ownerincludes partner,trustee,grantor,or corporate officer)of the property(s) <br /> Involved In this application,or <br /> E7 Legal agent(attach proof of the owner's consent to the application of the property's Involved in this <br /> application and have b6bwauthorized to file on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> I <br /> Print Name: S` Signature: <br /> Date:��l d <br /> Print Name: fl n <br /> I Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: 1 <br /> UPAPP FORM REV,Bd&n(fH0) <br /> 5 <br />