Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> AUTHORIZATION: S'IGNATURES.' . <br /> ONLY THE OWNER OF THE PROPERTY OR'AN.AUTHORIZED.AGENT:MAY:FILEAN APPUCAT[ON <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 /> ❑ 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 thea lic <br /> aon of the in this application and have been authorized to file on the€rbehalf.,and that the property's egoingVed <br /> application statements are true and correct. <br /> Print Name: �r -�i� t�d <br /> Signature: Date: <br /> Name: <br /> Print Name: <br /> Signature: Date: <br /> Signature: <br /> Print Name: <br /> Date: <br /> Signature: Date: <br /> Print Mame: <br /> Signature: <br /> Date: <br /> -5- <br />