Laserfiche WebLink
APPLK ION - SITE APPROVAL <br /> ALITHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORMED AGENT MAY FILE AN APPLICATION. <br /> Vie County Bnd as eyenro,oOlcerS eno <br /> I,tho O-neMApenfa9ree,to defend.Mdamnlly,ano 01014 nsrm/ea9 <br /> amployeas from any claim,ocuon or proeoeding Dgalnsl the Ownor1Agcnt'c projoct. <br /> 1,further, certify under ponal(y of pedurY that t am(cnecK ony: <br /> 0 Lopal,O ovorLY owner(owner lnc(tlde9 partner,[r"r",w9lor,or corporate offkcf)or the properry(s1 <br /> Involved 10.9 appI;coGon,or <br /> D LOAaI apenr(am7dr proof of the owner's consont to Ne APPIIcrINon of frit P vperfy,9 involved in VI:s <br /> application and have boon auihorited to filo on their Dehall and th o loregoing appllcatlon statements <br /> Jra true and correCL <br /> i <br /> Da[a 2J,( <br /> Pdnv Mame: �� Slgndlur0[ ^'�' � <br /> W ea: <br /> PIIDt Nan1al <br /> Sig—Wra: <br /> Print Nomc: <br /> Signnwrv: Dnrl: <br /> Print Name: Slpnawre_ <br /> Dula( <br /> Q�le: <br /> Prin[Nemo: S)pM1mo: <br /> TOTAL P.i <br /> TOTAL P.01 <br />