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f <br /> t, USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <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 project <br /> Owner/Agent's 'ect. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> io 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 file on their <br /> behalf., and that the foregoing application statements are true and correct. <br /> i <br /> Print Name; C:Y 1QICf$ Ase o Signature: Date: v�7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />