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Y <br /> r <br /> APPLICATION- SITE APPRO., <br /> AUTHORIZATION TION SIGNATURES TURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATIJand <br /> I, the Owner/Agent agree, to defend, indemnify, and <br /> the Owner/Agent's project harmless the County and s agents, officers <br /> employees from any claim, action or proceeding <br /> 1, further, certify under penalty of perjury that l am (check one): <br /> id Legal property owner(owner includes partner, trustee, trved in this <br /> ustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> consent to the nvo <br /> ved In this <br /> ❑ Legal agent(attach proof of the owner'sfile on their behalf., andlf that the foegoing cation of the app+licatioln s atements <br /> application and have been authorized to <br /> are true and correct. / r <br /> -14 <br /> � <br /> Signature: <br /> Print Name: ���� �+ n � �' �� g <br /> Signature: Date: <br /> Print Name: <br /> Date: <br /> Print Name: W Signature: <br /> Date: <br /> Print Name: Signature: <br /> Dater <br /> Print Name: Signature: <br />