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_ r) (-C, 0, INE ADJUSTMENT <br /> I <br /> SAN JOAQUIN COUNT? -AAM.. 1TYDEvELOPMENT DEPARTMENT <br /> AUTHORIZATION SJGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPL1CA770N. <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceedingagainst the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that)am(check One): <br /> O Legal property owner(owner includes partner,trustee,(ustor,or corporate Officer)Of the property(s)involved in this <br /> application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and have <br /> been authorized to Tyle on their behalf„and that the foregoing application statements are true and correct <br /> Print Name: Signature: yrs Date: 7 y U <br /> Print Name: Signature: ate: d <br /> Print Name: Signature: Date: <br /> l <br /> Print Name: Signature: Date: <br /> [7PfntName: Signature: Date: <br /> I <br /> I <br /> i <br /> 1 <br /> KIRKU6wsny00 DU4 REV IMI # <br />