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.f + ti <br /> r <br /> APPLICATION - SITE APPROVAL ; <br /> G PRIVATE RIGHT OF WAY-ANTIQUATED SUBDlVlS14N <br /> SAN JOA '&IN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED A GENT MAY FILE AN APPLICATION. <br /> 's <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmlethe County and Its agents,officers,and employees from any claim,action or <br /> ss <br /> proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> 01, Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the prgperty(s)Involved in <br /> this application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> C' <br /> Print Name. Signature: L U <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ,. y <br /> t `j <br /> N : <br /> F, e <br /> i . <br /> I} <br /> �.".�-�:j�:v .�,�-::.c:+. '.. .,,�.�:,. ��,:+..c -L--<. ��.:....�.f��.,. _� __ _�•..ter- �.-=A„'-,,�..i�• �:4""!+r*,.Y --x��+-,.. ��_'-.�e.....,,., �� <br /> , <br /> SITEAPPPDPRIANTIMMIVAPP M.9-9-01 (IHD) - - - - <br /> iF <br /> �i <br />