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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATIONSIGNATURES <br /> ONLY THE OWNER OF THE-PROPERTY'OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify/under penalty of perjury that I am (check one): <br /> 5 Legal property owner (owner includes partner, trustee, trustor, or corporate officer) <br /> of the property(s) involved in this application, or <br /> 0 Legal agent (attach proof of the owner's consent to the application of the property's <br /> involved in this application and have been authorized to file on their behalf., and that <br /> ��,�j7t'�he(foregoing application statements are true and correct. <br /> Print Name: ;pA%l�/ /J � �i^' Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />