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:I <br /> APPLICATION _ <br /> SAN JOAQUIN DEPARTMENT <br /> - COUNTY COMMUNITY DEVELOPMENT <br /> _ 3 `i tri b'^k�f; 'r':; »ice <br /> f3;�. k l23ti:3; .f. 3wa3a ai a .�uSX';•::7;;Lg <br /> �+y.#�.w;,v t��.�%��n`IAf'iTF•iORIZATIONSIs3NA ;. �y�,„f,3,� awl{°rs3' <br /> t <br /> �.�.�Sr:A;``�. <br /> .', -- :n.J•>_ :JV Ty"p{.jr�J,�w,: 'r}t����{' .`>dY a' ,ya w�ld. �. - <br /> dN Y� :OWNE>�CSi S�iEpNLIMH1TssOK'Atil0CJrFfQRt �`AO tiT�iik F(Li±AttTg7P�P %` ya 'A�'. ,:,,,'rte` <br /> CATTOPI...,r..s.. .. �" ; <br /> 1, the Owneeedi Agent agree,to defend,Indemn]ty,and hold harmless the County and its agents,afttcefs and employees from any claim,action prxeedlnp against the Owner/Agent's project. <br /> I, further, cartiry under penaltyil of perjury that I am(check one): <br /> §� <br /> Lea! <br /> ` s property owner(owner Incudes partner,trustee,trustor,or corporate officer)of the property{s}Involved In <br /> this!application,or. <br /> LegaI . <br /> l agent{attach proal of the owner's consent to the application of theroat <br /> and have been authorized to file on their behair.,and that the foregoing appllcatlon statements a enys involved Inttrue aind uon <br /> correct. <br /> Print Namelbmy'f <br /> Signature: Date: 71� d Z <br /> Print dame: !�1 / Signature: ... <br /> Date: <br /> Print Name: Signature: <br /> I Date: <br /> Print Name: ,s Signature. <br /> nate: _ <br /> Print Name: Signature: <br /> Date: <br /> 3: <br /> li <br /> Ih , <br /> II <br /> 'I <br /> I� <br /> II <br /> II <br /> !I i <br /> I 4 <br /> + 1 <br /> q r-- <br /> - <br /> II e <br /> I' <br /> J <br /> „ <br />