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r <br /> .' <br /> i <br /> APPLICATION - SITE APPROVAL <br /> AUTHORlZA7ION:'.SIGNAIURES <br /> ONLY THE OWNER 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 OwnerlAgent's project. <br /> 1, further, certify under penalty of perjury that l 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 /> aLegal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> pplication and have been authorized to fife on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: / G/ Signature. 4 Date: D <br /> Print Name: Signature: Date: <br /> r <br /> Print Name: Signafure: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> G <br /> F <br /> N <br /> rH.�sT• :.14 �/Vil�N'.�wV.�` -.^�gllwa +Yww�nn�_,.rww - _ ' '- +.w --w., _ - .sr- -�..:�.,n <br /> Fl1J �.rt' —�.-.-..e wrM.."'} r,p�-G..�.:.`S�sr. ✓• � � .�.- .y+.;u�.. <br /> 1 <br /> r <br /> r <br /> t <br />