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APPLICATION - SITE APPROVAL <br /> k , <br /> � � <br /> > x{�' kS.3m i t!..},.,.a.... 3 .#� 'k �� ��� � O �! �� }Jy�.y►'ii'C ' �x <br /> ONC�YTiE.OtNIBIER` Fk1 ,PROPR7"'�ORg1VA'{IPTHC)RIZ�EIAEIT,NIA 'FILEpN APP„ CAT1t3N, <br /> k <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 or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 am (check one): <br /> Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> volved 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 foregoing application statements <br /> are true and correct. <br /> Print Name:e:;sck)__V..j .,, -„J Signature: Date: 2 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: 5 <br /> Print Name: Signature: Date: <br /> l <br /> Print Name: Signature: Date: <br /> 1 <br />