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APPLICATION - SITE APPROVAL <br /> ACJTH.a1ZAT�DN.$10'AT IRDS <br /> ONLY 7HE OWNER OF:T14. a6PERTY OR AN At1THORIZED A49NT;MAY FILE AN' APfi� tCATION <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 Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am(check one): <br /> Li Legal property owner(owner includes partner,trustee,trustor,or corporate officer) of the <br /> property(s) involved in this application, or <br /> „ Legal agent(attach proof of the.owner's consent to the application of the property's involved <br /> ttiris appficatiori arict`liai+e�been authorizedo fiile on their�lialf.,and-thafthe foregoing <br /> application statements are true and correct. <br /> Print Name: '/-a Signature://irr�-- �rr+- a Date: � s <br /> Print Name: Signature: Date'. <br /> Print Name: Signature:' Date: <br /> Print]Name: Signature: Date: <br /> Print(Name: Signature:. ' Date: <br /> i <br /> 4 <br /> k , <br />