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4 <br /> i <br /> APPLICATION - SITE APPROVAL <br /> ACITHCRIZAT[DN S[Gft A. RES <br /> I <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGEN: I AI Y- Ii.E.AN `AL?PLfr,'AT14Ns:'. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <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 /> E: 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 1 <br /> in this application and have been authorized to file on their behalf.,and that the foregoing I <br /> j application statements are true and correct. <br /> I <br /> I <br /> Print Name: <br /> �lll vs� Signature: 1/I --�� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Date: <br /> Print Name: Signature: <br /> a <br /> t <br /> 4 <br /> l <br /> f <br /> f <br /> F <br /> L <br />