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APPLICATION <br /> a e <br /> - SANJOAQl1(NCOUNTYCQMMUN)TYpOEVE SUBDIVISION <br /> rs ` y} ENT 0EAARTMENT <br /> vy �v R <br /> .. 11T10RfZA•TI0NSiLiNATtlRis ' <br /> `'' .:. .. ,�,. -,. ..<•bN< .Tilt: f� E: OPE T'YsOR`AIV' .. CR (�E e. x #.�ya,�r. i 'a.9t�«r ,, Y aos <br /> OWne <br /> I,the ceedi Agent agree,to defend,fndemnlfy,and hold harmless the County and Its agents,officals and employees from any claim,acuort <br /> or proceedlnp against the Owner/Agent's project <br /> rI11,further, certify under penalty of perjury that I,am(check one): <br /> Legal property owner(owner Includes partner,trust <br /> 1 this application,or trustor,or corporate officer)of the property(s)involved In <br /> Lego!agent(aEtach proof of the f.,and <br /> correct, that the foregoing owner's consent to the appllcatlon of the propeKys involved In this application <br /> ` and have beep authorized to Ate on their behal ' a lication statements are true and <br /> { g PP <br /> Print Name: ks—GI <br /> Signature: <br /> i Print Name: Date: f 6 p <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> ' Signature: <br /> Print Name: Date: <br /> Signature: <br /> i Date: <br /> I �1 <br /> � k <br /> f ff <br /> jl <br /> ii <br /> rl <br /> E <br /> IE <br /> ,q_ <br />