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3: <br /> { # $' <br /> AUTHURIZATIQN SIGNATURES: >... <br /> x <br /> f 43 xzl ° <br /> ONLY THE OWNER OF THEkPROPERTY OR AN AUTHORIZED AGiENT MAY FILE AN APPLICATION. ..... .:........ <br /> r - <br /> nerlAgent agree,to defend,indemnify,and hold hannless the County and its agents,officers and employees from any claim, <br /> proceeding against the Owner/Agent's project <br /> certify under penalty of perjury that 1 am(check one): <br /> Legal property owner(owner includes partner,trustee.trustor,or corporate officer)of the property(s)involved in this <br /> application.or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoing application st tements are true a d correct. <br /> +: J 'Fils0 Signature: Date: /0— Z� <br /> Signature Date: 10-.2y- g7 <br /> Signatur Date: io oZQ-�y <br /> Signature: Date: <br /> Signature: Date- <br /> k9 :}:):4ii:•:i• <br /> : •Q .> t,4 ,y.:v '` :.5�y'-�;"i°:2':r..@:-6.:kcY' iFY.:.�:in.'t'',3+:i:cus:4.:h,ti:: ::{,E:::S,.?#..:f.r+,,f-'-if:':r:`y34a:T�n`CGie4.:"''dSSo?a:.:G:,'�J}z•:%ir?,+/fyyY:ckc�o-i;::i':g5:5=:::&:;:`.v;;'tiik'J`-'-;Gc.9il�,;,r.J'�.'f:c#-2rSr?:5:"L..;�',�-'.":�,.p <br /> gyp/ <br /> ..n.+a <br /> n:!24i{: ,syy <br /> STAFF USE OfVLY.:: <br /> i: <br /> gi <br /> .r._::::: <br /> ed By: Date: <br />