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APPLICATION - SPECIAL PURPOSE PLAN <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORrZATlON SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORRED AGENT MAY FILE AN APPLICAT70N. <br /> r0w"erlAgentagree,gree, todefend, indemnify,andholdharmless the County and its agents,officersandemployeeshom artyclaim,action <br /> t the Owner/Agent's project. <br /> er 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 owners 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: Cha/'�t'S ZG �.+� P� Signature: �.Z '<' / �Da . <br /> 1 <br /> Print Name: Signature: Dam <br /> Print Name: Signature: Daft <br /> Print Name: Signature: Dam <br /> Print Name: Signature: Da1e: <br />