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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY.;THE OWNER,'OF THE PROPERTY 00AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claim, action or proceeding.'agalnst the Owner/Agent's project <br /> 1, further, certify under penalty of perjury that/am(check one): <br /> 4?/ <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 /> f -"-� Dat��7.g� . <br /> Print Name: J � Signatur . <br /> Print Name. O • - z. Signature: Date: -&2 <br /> Print Name: Signature: A.A44Z Dat - I-0 <br /> Print Name: -i /�,1J2d7��, Signature; Date: 0.2 <br /> PrOat Nome. Si nature: <br /> I <br /> I <br /> i <br /> I <br /> I <br /> I- <br />