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.G <br /> APPLICATION - HOME OCCUPATION <br /> �' y< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �� • BL APPL. NO: BL- I j(XX�O I <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> I shall not employ any person other than a member of the resident family who resides on the premises. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s)involved in this <br /> application, or <br /> ❑ 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 foreg g application statements are true and correct. <br /> Print Name: OJ Ok 19 Q dcj Signature: Date: <br /> Print Name: Signature: Date: <br /> STAFF USE ONLY <br /> G/P Designation: L Zoning: 2- APN: <br /> DEPARTMENT APPR ED DENIED DATE <br /> Development Services V Planner Name: 3 <br /> Building Inspection <br /> Fire District — <br /> Environmental Health Div <br /> Public Works Department 8!9 <br /> M.H.C.S.D. <br /> License Approved For: I &D bEIL, <br /> Remarks: <br /> Accepted as Complete: Date: <br /> F:IDEVSVC1Planning Application Forms\Home Occupation.doc. Page 4 Of 4 <br /> (Revised 11-16-09) <br />