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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICA77and <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officeremployees from any claim, action or proceeding against the OwnenAgent's project. <br /> 1,/further, certify under penalty of perjury that I am(check one): <br /> L7Legal property owner(owner includes partner, trustee, trustor, or corporate oNicer) of the prop <br /> involved in this application, or <br /> 0 Legal agent(attach proof of the owner's consent to the application of Gte property's involved in this <br /> application and have been authorized to file on their behalf., and that the for application statements are <br /> true and correct. �y� �^ ,'�G/�. Date <br /> �/��c/��� S //(/�g/Signature: &-ZO _ :1 <br /> Print Name: g <br /> Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />