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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION .SIGNATURES �" ;r; <br /> i': <br /> ONLY THE OWNER OF THE-'PROpER:: TYOR AN!AUTHORIZEQ AGENT MA1G plagal AEP CATION. . <br /> I, 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 /> I, 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.ownees ent to the iicat" n of the property's involved <br /> in this application and have been au zed o file on and that the foregoing <br /> application statements are true an or" <br /> loqk�Print Name: Signature. Date: IV <br /> Print Name: Signature: Date: <br /> Print Name: Signature: pate: <br /> Print Name: Signature: pate: <br /> Print Name: Signature: Date: <br /> - 1 <br /> t' <br />