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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES s <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, oMcere and <br /> employees from any claim, action or proceeding against the Owner/Ayant'a project <br /> 1, further, cerft 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 /> Involved In this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved 1n this <br /> application and have Dean authorized to Me on tholr behaH., and Mat the foregoing application statements <br /> are true and <br /> /leo�rr/act. 1� l <br /> Print Name:/ /l� �t� 1 Signature. Dana 17—q <br /> D )qt2. I Signature:Name _ Date ' I <br /> i I <br /> Print Name.. Signature: Data: _( .._^ <br /> Print Name; Signature: Date: <br /> Print Name: Signature: Date: <br /> — —2/2:d 220924b602T :01 "S8SZE8T2T l6OS38 S33d1:W0dj Lt-:OT 66bT-8T-Fi0 <br /> 4 <br />