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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 MAY FILE 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 Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am(check one): <br /> It Legal property owner(owner includes partner, trustee, trustor,or corporate officer)of the 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 <br /> have been authorized to file or=their behalf.,and that the foregoing application statements are true and correct. <br /> 7 <br /> Print Name: -vv,, I��1 Signature: j Date: —44 Gl7, <br /> Print Name: K14 n II f k . t`�(/1.t4'( _ Signatur . Date: ; <br /> Print Name: _ Signature: Date: <br /> Print Name: _ Signature: Date: <br /> Print Name: _ Signature: Date: <br /> -s- <br />