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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> 7gdn <br /> NLYTHE�S&EaOFi;TIfEROPERTY,ORANAUTHORIZEDAGENTMAYF/LEAN APPLICATION. <br /> OwneNAgent agree, to defend,Indemnify, and hold harmless the County and Its agents, officers and <br /> yees from any claim, action or proceed/ng'against the Owner/Agent's project. <br /> her, certify under penalty of perjury that I am (check one): <br /> egal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> ed In this application, or <br /> egal agent(attach proof of the owner's consent to the application of the propertys Involved/n this, <br /> ation and have been authorized to f//e on their behalf., and that the foregoing application statements <br /> e and co77rrr�rect.ame: t J jSignature: <br /> ame: Date.Signature: <br /> me: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Namef Date: <br /> •lpn�tuni <br /> Dotal <br />