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i <br /> APPLICATION SITE APPROVAL <br /> x <br /> F ME <br /> A UTH0171Z�1 TION SIGNATURES <br /> 41YLY THE OWNFR OF THE PROPERTY:OR,AN A UTHORIZED AGENT"MAY FEAN APPLiGAT10N <br /> i, 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 against the Owner/Agent's project. <br /> E 1, further, certify under.penalty of perjury that 1 am (check one): <br /> t <br /> C1 Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 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: <br /> Signature: /le() � � Date:1—,70 <br /> Print Name: p Signature: Date_ .ra <br /> . Print Name: Signature:9 Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> i <br /> i <br /> 's <br />