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APPLICATION - -SITE APPROVAL <br /> AUTH9Rf-'.1 a-"ON �NArU ,{tg <br /> ONLY THE OWNER OF THE PROPERTY OR AKAUTHORIZED AGENT MAY FILE AN APPLICATION._ <br /> [1, theOwner gent agre to defend, indemnify, and holrl harmless the County acrd its agents, officers and employeesm any claim, ac ion or proceeding against the 0wlic;lAgent's Project. <br /> urther, certify under penalty of perjury that I am (chack.one): <br /> ❑ Legal property owner(cwrer in,4u.des partner, trustee,trustor, or corporate officer) of the <br /> pr^party's) ;rtv cl:ad in t':'_ cpplFcat pr, a.' <br /> Legal agsnt (attach proof c Vie is iner's consent to the application of the property's involved <br /> in this application artd have bn:m authorizca to file on their behalf., and that the foregoing <br /> a�pplic/a/tion statements are f—ru4 And correct. <br /> Print Name: krnes Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> NORnt COON77 AeorecT <br /> -5- <br />