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- APPLICATION - LOT Lr <br /> i4E ADJUSTMENT <br /> " V. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ' I, the Owner/Agent agree, to defend, Indemnify, and hold harmless the Count and its a ent <br /> employees from any claim, action or proceeding against the Owner/Agent's project. g s, officers and <br /> 1 <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of <br /> pr the owners consent to the application of the property's involved in this <br /> application and have'been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct, <br /> III Print Name: l Signature: <br /> Print Name: F Date: <br /> Signature, Aate: �ZCJ 5 <br /> I� Print Name: Signature: <br /> Date: S Ilo O� <br /> + Print Name: Signature: <br /> I Date: <br /> I Print Name: Signature: <br /> Date: <br /> I <br /> 11 <br /> i <br /> i <br /> Ij <br /> I <br /> I� <br /> j <br /> i <br /> `I <br /> i <br /> 11 r <br /> i F:waysvCU%mi„g Appkation p� <br /> LwPage 5 of 7 <br /> umAa � �y <br /> I� <br />