Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> AUTHORlZA:TI�N SJGNATURES: < ` �: <br /> QNLY 7HEOWN1 R OF::THE PR©PERTY OR AN AVTHORIZED:AGENT MAY FILE i�N APPLIGATl N. <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 OwnerfAgent'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 /> volved in this application, or <br /> -Q Legal agent(attach proof of the owner's consent to the application of the property's involved in this + <br /> application andhave been authorized to file on theirbehalf.,and that the foregoing application statements are <br /> true and correct. <br /> Print Name: Signature: Date: $ WE) <br /> Print Name: Signature: Date: <br /> E Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date. <br /> y <br /> 1 <br /> k •_ <br />