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c * a <br /> (7JT LINE ADJUSTMENT <br /> SAN JOAQU1N COUNTY COMMUNITYDEMLOPMENT DEPARTMENT <br /> AirT110121ZAttON SK3HA7URE$' `' r .;� - <br /> QN1.YfF�tDWkM . AOPEIiMCFtAH.l1UT1K�kET2EAA0ElV7 AG4Y..FALSdN.igF�ALICA11bH ,s; . . <br /> 1,the Owner/Agent agree`,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agenes project. <br /> 1,further, certify under penalty of pwjuty that I am(check(ne): <br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)Involved to this <br /> appllcadot4 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 authorised to file on their behalf.,and that the foregoing application sietements are We and correct. <br /> Print Name. � S/ ture: Date: S 4 <br /> Print Name: igna Date. <br /> Print Name: ignature., Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> i <br /> a <br /> i <br /> R <br /> E <br /> E' J <br /> i I <br /> i <br /> J. � <br /> I` <br /> I' <br /> - �=-•r�� - +ten. ..-'��.r.� <br /> i <br /> 10:0.3 AMr^„uoa F,a+wV 1,109 <br /> x <br /> I <br />