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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> oNLYTHE OWNER,OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwneNAgent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employe"from any claim, action or proceed/ng against the OwneNAgent's project. <br /> 1, further, certify under penalty of perjury that I 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 /> O 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: S-LIME-5 /- Signature: Date: U ' <br /> Print Name: �i//N �p�/�t�j Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Prtnt Nam*$ ele/laturet DatN <br />