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APPLICATION - SITE APPROVAL <br /> AUTHORMA.-IO1�E`SIGNATURES.:. <br /> ONLY THE OWNER OF'THE PROPERTY OIt At4 AUTHORME1a:AKGEIt `MAY.'FILE-AWApP...EICATfOM. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employe <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that I am (check one): <br /> 4G Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involvec <br /> in this application and have been authorized to file on their behalf., and that the foregoing <br /> application statements are true and correct. <br /> Print I Name: n�^ 1 r.'C Signature: ar „Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: — Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date; <br />