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J <br /> USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: UP- _ <br /> � z <br /> OR/ZA.f�-.Q <br /> otn maize"dA" erit�Ma"' F.fle'Patf�Av lication' ' t <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 OwnerlAgent'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 /> O 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 file on their behalf.,and that the foregoing application statements <br /> are true and correct. <br /> Print Name:SV ( �br� Signature: o <br /> Dater 03. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: <br />