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APPLICATION - SITE APPROVAL <br /> -AUTHORIZATION SIGNATURES <br /> � . <br /> ONLY:°THE QWNER:'C?F.7HE PRORERIY,OR AN'AUTHORIZED'AGENT MAY'F1LE 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 claim,action orproceeding'against the Owner/Agent's project. <br /> -- ;- h1, further;-certlfy-under penalty-of pe airy -(c <br /> that barnheck one): <br /> I • <br /> L7 Legal property owner(owner Includes partner, trustee, trustor, or corporatd officer) of the property(s)• <br /> Involved In this application, or <br /> Legal Le9 g (attach proof of the owners consent to the application of the property's Involved in this <br /> , <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct <br /> Print Name: i Signatur [1 Da to ' f Z <br /> 4�i_ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> I ' <br /> i <br /> i <br /> I <br /> • <br /> j <br /> j <br /> t�. Y` <br />