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APPLICATION - USE PERMIT <br /> AUTHOR'ZATION SIGNATURES <br /> ONLY T.HE OWNER OF THE PROPERTY OR'AN AUTHORIZED AGENT MAY FILE AN APPLICAT16N.. <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, fu er, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> L <br /> volved In this application, or <br /> s:�Fa,�w`d „�pw,,:g,. ,..::- - �s-�-,c+.�ti.•x�s.i:{.5�. _:; :�._-' ,;,. .. . <br /> '- Legal agent{attach proof of the owners consen-Cr the application Orthe pYnperty`s Involved In nils—— Y <br /> pplicatlon and have been authorized to file on their behalf.,and that the foregoing application statements are <br /> rue and correct <br /> Print Name: & / Signature: Date: d r <br /> Print Name: Signature: Date.- <br /> Print <br /> ate:Print Name: Signature: Date.- <br /> Print <br /> ate:Print Name: Signature: Data. <br /> Print Name; Slgnatura: Dater <br /> 4 <br />