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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLTNORIZED AGENT MAY FILE AN APPLICATION <br /> 1, the Owner/Agont agree, to defend, Indemnify, avid hold harmless the County and Its agents, officers and <br /> employees from any claim, action or procoeding'agalnst the Owner/Agent's project. <br /> 4 further, certify under ponalty of perjury that 1 am (check one): <br /> GZX Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Involved In this application, or <br /> O 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 theitbohn.;egoing l/., and That the application statements <br /> aro true and correct. <br /> Print Name: David Vaccarezza SlgnDate: 10/3/03 <br /> Print Name: SlgnDate. <br /> Print Nam o: Slgnaturo: Data: <br /> Print Name: Slgnaturo: Dato: <br /> p.br <br />