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APPLICATION - SITE APPROVAL <br /> .......................................... <br /> .............................. <br /> ........... . ....... ... . .. <br /> ............................. .AUTHORIZATION SIGNATURES ....... .. .... <br /> .......... <br /> ............................. <br /> ............. <br /> ..... ..... <br /> ................:::N:..................... ............... <br /> ................ .........­:.............. ........... ................ .......... <br /> ..............I...............................�.............: 1�1 . <br /> .......... ........... ............. .. <br /> ........ ......... <br /> ­-­ ONLY THE OWNER ... <br /> .. <br /> ............... <br /> OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLlCATlON.:...:::::!X:.: <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 /> /XLegal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 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 are <br /> true and correct. <br /> Print Name: 3ngf1 d"'C2 Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />