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l� -a0r1� <br /> ¢4U,".. APPLICATION o ROME OCCUPATION <br /> Vco <br /> OCT 0 6 2015 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i�VIRONMENTAI.HEALTH <br /> BL APPL.NO: BL- s <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,furt er, certify under penalty of perjury that I am (check one): <br /> Lega <br /> I 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 foregoing application statements are true and correct. <br /> Print Name: Q�� n Signature: Date: <br /> Print Name: Signature: Date: <br /> STAFF USE ONLY <br /> GIP Designation: L Zoning:'-L APN: <br /> DEPARTMENT APPROV D DENIED DA E <br /> Development Services Planner Name: U <br /> Building Inspection <br /> Fire Distrlct rn06 -- — ---- <br /> Environmental Health Div C� Su DD 10&53 11b dlo !S <br /> Public Works Department <br /> M.H.C.S.D. �-- <br /> License Approved For: IVW Ufa nl� . -t;-UA ucA4�d <br /> Remarks: <br /> Accepted as Complete: Date: <br /> 3pplic35ons and handouUp(anning forms/home occupation Page 4 of 4 <br /> tevised 8-12-13) <br />