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APPLICATION-MINOR SUBDMSION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless fire County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> I,further, certify under penalty of perjury that I am(check one): <br /> OX Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of fire property(s)involved In this <br /> application,or <br /> O 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 file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: DANIEL ROCHA Signature: A''.;n� F /;s -A ate: f5 `2 e� a <br /> Print Name: Signature: Date: <br /> Print Name: JERRY ROCHA Signature: d Date: Z - ,21) - 3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> IIIIIOA'Mwp►OWI REV. 8-10-01 IIHDI <br /> -5- <br />