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} <br /> APPLICATION - SITE APPROVAL <br /> ONLY THE O.WNEROFTHE:PROPERTY!:OMAN:::AUTHORM :AGEu MA,YrFIT�.ACI�,ICPPUI.'d1�'1-fb11i ..:<.:.. ..; <br /> I, the Owner/Agent agree,to defend, indemnity,and hold harmless the County and its agents,officers and employee <br /> 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 /> ❑ Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of the <br /> property(s) involved in this application,or <br /> 1� Legal agent(attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf.,and that the foregoing <br /> application statements are true and correct. <br /> Print Name: Lo i Signature: i Date: G <br /> Print Name: Signature: Date: <br /> Print Name: Signature: pate: <br />` Print Name: Signature: pate: <br /> Print Name: Signature: Date: <br />