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APPLICATION - SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAYFILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,indemnify,and hold harmless the County and Its agents, officers and employees from any claim,action <br /> or proceeding against the Ownor/Agent's project. <br /> 1, further, certify under penalty of perjury that I any(check one): <br /> A Legal property owner(owner Includes partner, trustee, trustor, or corporate officer)of the property(s)Involved In this <br /> application, or <br /> 0 Legal agent(attach proo l of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: CSL c'.�- Signature: P� 1.q P Date: <br /> 'zJPrint Name: , �C� Y-1, Signature; Date; <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Namo: Signature: Date: <br />