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A � <br /> APPLICATION - SITE APPROVAL <br /> AUTHQRlZATIQN;SIGNATURES <br /> .:ONLY THE OWNER OF THE PROPERTY OR AN�4 UTHORIZED�1GEN1'.MAY F1LE AN'APPLICAr1�N <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!am (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 /> )kLegal 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: f tc7(fv signature: Date: 03 <br /> Print Name: signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date <br /> Print Name: Signature: Date: <br />