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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER,OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwnerlAgent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claim, action or proceeding agalast the OwnerlAgent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> O Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Involved In this application, or <br /> 63c 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 /> Print Name: Donald F. Rodgers Slgnaturo: � <br /> Print Name: Date: 3- (_i _p <br /> Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Print N.m.i Do to: <br /> •lpn.eur.r <br /> A.ur <br />