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APPLICATION - USE PERMIT <br /> SAN JO! UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "a 3 d'O k .� . ) FS'Y� <br /> 'r, r a 3 a {j►Ys f� QCs ? A45�5j „VSs Yucc'L ) fi.31k)w»�iN/ <br /> .dRC j '.e. Ya, Y.'4r /kR6YM5k�' Yl`A€ '1'HQtIQ' 'IC1t+th5(GIA'I" 11�S��Y° H Ss#R�F/a R'Y3'u[3o C9Q' <br /> .,.;ONI^f'ENE`t)S'IfNEROFTHEt'ROPERT'�ORATtAt}THOflIZF_D'A6ENTMAYfi[.EAI�'/tPPL1CkTtON. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers 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 /> 21"' Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> of the property(s) involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's <br /> involved in this application and have been authorized to file on their behalf., and that <br /> the foregoing application statements are true and correct <br /> Print Name: YLANIL C �L ��E S� Signature: Date: ,r�)201 gg <br /> Print Name: HU-EN C ft OSI ZJ� Signature: Date: 5Zo , <br /> Print Name: Signature: Date: <br /> Pnt Name: Signature: Date: <br /> L'n"ntName: Signature: Date: <br /> -5- <br />