Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
USE PERMIT <br /> SAN JOAQUINXX;COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> � :�l <br /> ` rctWnm �' Srg $ " r Y 'K Hgzya <br /> .,-�p,AUTHORIZATION�,SIGNA.T,URES � <5 <br /> ? . :'�"y '+ �>; r�k,, �°�."r}'�'S <br /> ONLY THE OWNER OF THE PROPERTY OR-AN AUTHORIZED i4GENT MAY,F/LE`AN'APPGCATION.=" <br /> 1, the Owner/Agent agree, to <br /> g 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 project. <br /> i <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> I <br /> o 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 /> Print Name: . �� '� (�a /� "�A Signature: j /� C,— Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />