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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE'OWNER„OF THE.PROPERTY.OR'ANAUTNORlZED`AGENT MAY FILE AN'APPLICATION: <br /> 1, th Ow Mgent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claim, action orproceeding;against the Owner/Agent's'project. <br /> _ l,i;-further;�certlfy-under-penalty-of perjury-that-1-am=(checed,r 6):` <br /> Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> - Involved In this application, or <br /> -© 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 <br /> are true and correct. <br /> i <br /> Print Name: _ � <br /> t 'CZ ka) O L') Signature: Date: Jr' - Q 0- <br /> Print Name: Signature:. Data: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Bata: <br />�' Irrrnt Nwnr�r �lpn+�turwi a�«t <br /> No F$OWN <br /> E <br /> i <br /> i <br />