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:I <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER-OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,Indemnify,and hold harmless the County and Its agents, officers and <br /> ,employees from any clalm action or proceeding against the Owner/Agent'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 of Icer) of the property(s) <br /> volved In this application, or <br /> O Legal agent(attach proof of the dwner's consent to the,appllcatlon of the property's Involved In this <br /> application and have been authorized to file on their behalf.,and that the foregoing application statements are ` <br /> true and correct. <br /> s <br /> PNni Name: <br />- -- Slgnafur+a Date: <br /> Print Nance: .ST0*6 <br /> Signature: Date: <br /> 3 1-oY <br /> Print Name: Signature: Date:_ <br /> firint Name: Signature: <br /> Prine Memel al0nat4,r r' <br /> PerotIF <br /> f <br /> ' a <br /> i <br /> ' , 1 <br />