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t <br /> APPLICAT'ION --- LOT LIN <br /> SAN JOAOUIN COUNTY COMMUNITYOP <br /> . '`. FILE NUMBER: ■ <br /> Ct-0i•�F p�j�•F <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the.Ovmer/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that 1 am (check one): <br /> 01 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 the owner's 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. t <br /> Print Name: Signature: date: !1� <br /> Print Name: Signature ate: 1 6 <br /> Print Name: Signatur bate: <br /> Print Name: < E'V&IL-v Signature: Date: <br /> Print Name: t-7.p. �;727:Signature: . Dale: 7 P?g Vo <br /> ROEVSVMPIanntng'Appllcaliari Formal <br /> Loi Line Adiustrnen[.doc.(Revised 6-4-04) <br /> E <br />