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APPLICATION - SITE APPROV <br /> AL <br /> AUTI-IORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY f?q0 N AUTHOR/ <br /> I' the Owner/Agent agree, to defend, indemnif ZED AGENT MAY FILE AN <br /> emp/oyees from an Y and hold harmless the Count APPLICATION. <br /> y claim, action or proceeding against the Owner/A east's <br /> County and its agents, officers and <br /> 1, further, certify underPenalty project. <br /> penalty of perjury that l am (check one): <br /> � Legal proper? <br /> involved in this application,owner ,(owner includes par7ner, <br /> pplication, or trustee, trustor, or col <br /> porate officer) of the proper7y(s) <br /> Legal agent(attach proof of the owner's consent to the a <br /> cpplication and have been authorized to file on their behalf and <br /> are true and correct. application of the propert <br /> iliat the forego. jrs involved in this <br /> g application statements <br /> Print Name: r <br /> Signature: <br /> Print Name: �j/--do Date: <br /> Signature: , <br /> Print Name: <br /> Date: <br /> Signature: � <br /> Print Name: <br /> Date: <br /> Signature: <br /> Print Name: <br /> Date: <br /> Signature: �— <br /> Da to: <br />