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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> 51 <br /> '��L �( i� � �'i3il /"N4 �� �er.i 4a ,��n,:t`p:�+�y41 , 1i' abs h'•' � I-ii <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, <br /> officers and employees from any claim, action or proceeding against the Owner/Agent's protect. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> o Legal property owner(owner Includes partner, trustee, trustor, or corporate <br /> officer) of the property(s) involved In this application, or <br /> o Legal agent(attach proof of the owner's consent to the application of the <br /> property's Involved In this a--11_ean d �avc been <br /> behalf., and that the foregoing application statements are true and correct <br /> orized to We on rhelr <br /> Print Name: Pou110-5 5 %q Ior 50rviee. <br /> Y r. %�� Signature: c12' Date: 12/31/01 <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Data: <br />