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USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> MY <br /> ';#IdfMCi..f2.7C"..kSLSz'aJIY. .� `�! T ✓ _ v <br /> �t _.•!f�"r�.r .1.. �.y:SN .riR1i. WM.� � T . ... M.. <br /> • � ,�;.�Y. ONLY:�THEOWNEROF,�THEP.ROPERTY:�ORAIY OR/ZED�t3ENT f7 AN •P CA <br /> 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 1 am (check one): <br /> M Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> officer) of the property(s) involved in this application, or <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: John Bender Signature: L:& Date: <br /> Print Name: Signature: V Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />