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APPLICATIONS - USE PERMIT, <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> ... - } - �,,.; :. ;fir;r:,.',<.:a, �:-.:Y. ?. ,' c <br /> ;;:,.I1l1THORIZATIUN SIGNATURES <br /> .. <br /> .:: F t . '..r?Y.:�..:- ..�<,:-z.. . ... .. ; ? i. ?:.. t# ?--' �. j s ::::' <br /> $$.'. .'t;. 5..:.t},>RU'! THE OWNER OF THE PROPERTY OR ASM AUTHORIZED AGENT MAY FILE AN AF'PUCArtfON. r >'#! <br /> a.. ,s 3 r <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, oRicers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> o Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> of the property(s) involved in this application, or <br /> o Legal agent(attach proof of the owners consent to the application of the property's <br /> involved in this application and have been authorized to file on their behaif., and that the <br /> foregoing application statements are true and correct. <br /> I n r <br /> k ` <br /> Print Name: -Q 1'�H � 7:;!E Signature Date: <br /> Print Name: Signal e: Date: <br /> Print Name: Sign ure: Date: <br /> Print Name: Signature: _ Date: <br /> Print Name: Signature: Date: <br /> E <br /> i <br /> 7 <br /> ' H <br /> i <br />,l <br />