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y <br /> APPLICATION - SITE APPROVAL <br /> t <br /> . AUTH4RI�ATI,ON' SI,GNaTURE$ , <br /> ONLY THE OWNER OF THE PROPERTYOR AN ENT;MAY FILE AN AP..PL lCAT10N <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 lam (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> i <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 /> R L <br /> Print Name: e, <br /> v� Signater <br /> : 7-6,3 <br /> Dat , (p <br /> Print Name: <br /> - 4NIM�t x Signature: ._.Date: (b"24"63 <br /> Print Name: _� tN YAG i C�1' _ SignatureAl <br /> /(�. Date: G-L7-6 3 <br /> Print Name: IJ i 1,4 Signature: atg; fb�27wc3 <br /> Print!Name: Signature: _ Date: <br /> 1 � <br /> k <br /> f .3 <br /> •r <br /> k <br /> a <br /> I <br /> 0 <br /> 1 <br /> i. <br /> , <br />