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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTiMgNT <br /> 5 Xj"5 5 <br /> � efy�a Y4'rr4' ;.t`m°y' u i¢!f-�3«:u&'`�'§y. `:ek5t,w✓4."r °`,ws ,', - <br /> s5 <br /> r <br /> � UT 4 ' }I�TIQISINITVFjj� <br /> 4 sr'L?•'.1•: l .,y .g, ','r; .4g Fx 0.5 / x"'�` .4:- �.�;,4`si - .i.14 r t, ' Ra <br /> a <br /> ONLYTNE'OWNERbF.:TNEP..ROP_ERTY.ORISKAUTF(O.IZEFAGENT WAy,,R' ANI,4!?P1IGATTQN.„=,,:fir, Wa <br /> E 1, the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents, <br /> officers and employees from any claim, action or proceeding against the Owner/Agent's project <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> o Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> E officer) of the property(s) involved in this application, or <br /> { <br /> o Legal agent(attach proof of the owner's consent to the application of the <br /> property's involved in this application and have been authorized to rile on their <br /> behalf., and that the foregoing application statements are true and correct. <br /> Print Name: <br /> h� til � <br /> D I L L4 Signature: <br /> Signature: Date: <br /> Print Name: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Date: <br /> Print Name: <br /> Signature: <br /> I , <br /> fE <br /> I <br /> 4 <br /> if <br /> I <br />