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APPLICATION - USE PERMIT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _.. <br /> . <br /> :AUTHORIZATION SIGNATURES ......: :. ...... ::: <br /> }> <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPUCATION.•.••.»»•ss>s .ss.s. <br /> I, the Owner/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 I am (check one): <br /> o Legal property owner(owner includes partner, trustee, trustor, or corporate officer) <br /> 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 property's <br /> involved in this application and have been authorized to file on their behalf., and that the <br /> foregoing application statements are true a orrect <br /> Print Name: Tose J. Rios Signature: - Date: 11/14/97 <br /> Print Name: Signature: Dom: <br /> Print Name: Signature: Dom: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -o- <br />