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.1anT aY: Wt UVS JIUHt UAKLtY,UAj `JYO WD =92; NOV-2U-Ua 11 :JJAM; rage nin <br /> APPLICATION..;-..SITE APPROVAL <br /> PMATE R'lGHT OF WAY-AgnQUATED St1MPMON <br /> �Iytt1�R: 13w. <br /> Clw+Ywe any Mems of tmoncm ar MMA88000W <br /> .., _klhlY at on-off[&a. OF svucWree <br /> Oesarfbe on-sYruaQdb of a pp �, <br /> I <br /> osacobam pima or054ft d 2' orrelfeaWa <br /> J /7 <br /> Dawribs any onetla or orLsas saw*atolt0l' <br /> Dmalbs diq4caywA of pmpis ant WE be qmW by ale (a-g-manbers of .. ...haft unb <br /> 1, the OwnerfAgent agree, tp domvtt tndomnity,.ard hold hsmrm the County and its agenf5, offiOers and <br /> erty>foYees from ally cWgn.SCUM or paooee lkrg against the OM7re AgwWs projoa <br /> 1,further.cwtrfY under ply of perpuy that 1 em(check one) <br /> Legal property owner(owner includes partner,trustee.treator,or corporate of5oer)of the propertY(s) <br /> kroolved in this appkcatforl,or <br /> ❑ Leo agent(attach groat of the owner's consent to#m apphaatkrn of t or propedo knohred in this <br /> appecadm and have been autlnor W tp Ne on their hehaff.. and that the foregoing applkMlon statements <br /> are true and correct- <br /> Print <br /> orrectPl.0 rren»: v^ 1 v �— � oae: %\I JA <br /> tk:le won: - Deft. <br /> Pre wme: - S Dae: <br /> t'rkrt wms : Data: <br /> w,s Dime: Abse asta: <br /> mom. e.o Pap sof 7 <br /> b -d BOOE-LSS-602 �o?ii eLO :60 90 le AOW <br />