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i <br /> APPLICATION - SITE APPROVAL <br /> AUTHQRIZ T[04'SIGNATURES <br /> ONLY THE OWNER OFTHE:PROPERTY OR.AN AUTHORIZEOAGENT—WAY FILEAN..-APPLICATIOW <br /> 1, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employee <br /> from any claim, action or proceeding against the OwnerlAgent's project. <br /> I <br /> I, further, certify under penalty of perjury that I am (check one): <br /> I <br /> Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> ❑ 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 /> I <br /> Print Name: L�l��}S Signature: ZY100111L' Date: _ G� �/e, "�1 <br /> jPrint Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ry <br /> n <br /> M <br />