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a <br /> n <br /> r <br /> APPLICATION - SITE APPROVAL <br /> A UTHORIZA TION SIGNATURES <br /> ONLY THE OWNED 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 claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that 1 am (check one): <br /> xLegal 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 foregoing application statements <br /> are true and correct. <br /> Print Name: L Signature: 'i t Date: 1—�26 —6)b <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> E <br />