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USE PERMl7 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMEN7 <br /> FILE NUMBER: UP- <br /> AUTHORIZATION SIGNATURES <br /> Only the Owner of the Property or an Authorized Agent May File an Application <br /> 1, the OwnerlAgent,agree to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project. <br /> I further certify,under penalty of perjury, that I am(check one): <br /> 0 Legal property owner(owner includes partner, trustee,grantor,or corporate officer) of the property(s) <br /> involved in this application,or <br /> 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: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> UpA r MREV.b ISW(IND) 5 <br />