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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION.SiC NATU RES:: <br /> ONLY THE.OWNER:OFTHE PROPERTY-". <br /> WAN: -'ATfO€1t. ..::. . <br /> 1, the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employee <br /> from any claim,action or proceeding against the Owner/Agent's project. <br /> 1,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 <br /> Z <br /> roperty(s) involved in this application, or9 <br /> Legal agent(attach proof of the ownees consent to the application of the property's invo€ved. <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: Signature: Date: <br /> f� r <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> r <br />