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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 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 /> 1,further, certify under penalty of perjury that 1 am(check one): <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 /> Pdnf Nama: 9 <br /> ROGER LISTON Signature: Date:6-11-99 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />