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APPLICATION s SITE APPROVAL <br /> lila V liiil ij i'id"I':;14 .I ':e n 1 u ii'ill wl !.,ii {. r I "'; :'_t';: I :IfiS E:`,`h:.-' Ems' f rl -n', }r I.. ""•�. n 'L -:Y* k k;f`i'• M11G¢ nmlBal't5 El,ex r _Ei <br /> 7k <br /> I��R"/-'.l�rSJ �'l�P'��:%-R• � �\�� 4lllJ r s ` "C <br /> ` ' ni <br /> _w > � sq � ap '.,�, a ;a E', kap`, i i E61 <br /> ,:. �y <br /> DN X T T.,ow..ER �ILF�}� ��1bN�� <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 i am (check one): <br /> I <br /> 0 Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> f involved in this application, or <br /> k <br /> © Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> ti application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: A( 6)` Signature: (4, / 6-0e—[ Q ^ Date: <br /> Print Name: Signature: Date.- <br /> Print <br /> ate:Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:, <br /> 141 <br /> i <br /> I � <br /> r <br /> a <br /> s <br /> f <br /> a <br />