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x <br /> APPLICATION - SITE APPROVAL <br /> AUTHORMI'TIONSIGMA RES <br /> ONLY THE:OWNER:OF'THE:PROPERT`l.QR`Al1E.AUI' ORtZE#S i�CGE1tt MAY..FlCEAI <.piPPt(C/ 7`iQ111 <br /> I, the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents, officers and employee= <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I,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 <br /> property(s) involved in this application,or <br /> Cl Legal agent(attach proof of the ownees consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf.,and that the foregoing <br /> application statements are true and correct. <br /> f L"', AF7 <br /> Print Name: C!Ri P+%k3T l h ria Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> t <br />