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f {�'-• is � w 4 � . - <br /> R <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION.SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> f, the Owner/Agent agree, to defend, indemnify, and hold harmless file County and its agents, officers and <br /> employees from any claim, action orroceedin against p g g the Owner/A en <br /> g t s protect. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> 0 Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Involved in this application, or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf. and that the <br /> foregoing application statements <br /> are true and correct. Pp <br /> Print Name: Signature: — Date: _ ��017�. <br /> Print Name: Signature: Date: <br /> Print Name Signature: Date: <br /> Print Name: Signature: late: <br /> Print Name: Signature: Date: <br /> I <br /> 4 <br />