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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 OwneNAgent's project. <br /> 1, further, certify under penalty of perjury that I am(check one): <br /> O Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) AIN property(s) <br /> Involved in this application, or <br /> e 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 are <br /> true and correct. <br /> 12 <br /> Print Name: Fenton B. Jacobs Signature. t' Datew7-/ Di <br /> Print Name: Signature; Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Dab: <br />