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it <br /> - I <br /> APPLICATION - SITE APPROVAL <br /> ly <br /> 11F <br /> i6 <br /> .:'AUTHORIZATION SIGNATURES <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, officers and <br /> employees from any claim or against the OOw" ner/Agent's_.pr_ojec.t__ <br /> 1, further, 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) <br /> involved in this application, or <br /> ❑ 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 their behalf., and that the foregoing application statements <br /> are true and correct. <br /> I <br /> Print Name: Mark Jiirich Signature: �, ,J Date: 6/28/02 <br /> A <br /> Print Name: '' Signature: Date: <br /> Print Name: ' Signature: Date: <br /> s <br /> II ,. <br /> Print Name: iR Signature: Date: <br /> it <br /> Print Name: <br /> Signature: Date: <br /> I� <br /> l <br /> i_ <br /> I! <br /> a . <br /> I <br /> Ik . <br /> I <br /> fF! M k <br /> i :,•• i <br />