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APPLICATION - SITE APPROVAL <br /> AUTHORIZATIOU SIGNIATURES <br /> ONLY THE,OWNER'OF THE PROPERTY OR'AN AUTHORFZEi]AGE1�T'MAY FII-E AN'.:AFt�l,iCAT1QN: <br /> 1, 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 OwnerlAgent's project. <br /> 1, further, certify under penalty of perjury that 1 am (check one): <br /> Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of the <br /> property(s) involved in this� ( ) s application, or <br /> n Legal agent(attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf.,and that the foregoing <br /> application statements are true and correct. <br /> Print Name: "#" 5tgnatur : r <br /> Date: <br /> Print Nara �� <br /> l�— Signa re, Date: <br /> Print Name: Signatr.�te: <br /> f Date: f <br /> i Print Name: Signature: !!! <br /> Da#e: <br /> Print Name: Signature: Date: <br /> 3 <br /> l <br /> f <br />