Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> AUTHOR/ZAT/ON SIGNATURES <br /> rthOo <br /> THE'OWNER.OFMPpROPBRTX,OR AN"At/THOR/tEDAOENTMAYFILEgN PPL/CAT/ON. <br /> er/Agent agree, to defend, Indemnify, and hold harmlessthe County and!ts agents, officers and <br /> from any claim, action or proceeding against theOwnethe Co n project.certify underpenalty of perjury that l am (check one): <br /> roperty owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> this application, orgent(attach proof of the owner's consent to the application of the property's Involved/n this, <br /> application and have been authorized to We on their behalf., and that the foregoing application statements <br /> are true and correct <br /> Print Name: Gt hA4 o Zd � <br /> Signature: <br /> PAntName: 'L/a � �l,°.�. A. G „ t,�. - S - — Date: 2 ,2I-0 <br /> Signature: l( <br /> Print Name: Low;,rQ ('c(`u Date: 2. -2/-o' <br /> Signature: °--at <br /> Print Name: Signature: Date: <br /> Print Name! <br /> —� <br /> a1ffn•tunl Date: <br /> *tat <br />