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USE PERMIT 3 <br /> SAN JOAQUIN COUNTY COMMUNITYDEVELOPMENT 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 Owner/Agent's protect <br /> 1, further,-certify-urderpenalty of perjury that I am (check one): <br /> o Legal property owner(owner includes partner, trustee, trustor, or corporate <br /> officer) of the involved in this application, or <br /> �( -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 /> Print Name: Chcwrles T qn GSie_�rT Signature: 1 Date:4! _ � <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />�I <br /> f <br />`i � <br />