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,r <br /> r, <br /> APPLICATION - SITE <br /> APPROVAL <br /> AUTHORIZATION S[GNA.:TURES <br /> ONLY THE OWNEROF THE PROPERTY OR AN-.'AUT140 RIZEDI AGi=UrMAY..FILE AN APPU'CATTQN.. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employee_ <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> f 1 <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 g g proof of the owner's consent to thea application of the he 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 /> Lt� <br /> Print Name: _ "— Signature: N?ate: S <br /> _ZL <br /> Print Name: Signature: mate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I� <br /> 4 <br />