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1 <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED(AGENT MAY RLEAN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> )E� Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> O Legal agent (attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on Uleir behalf.,and that the foregoing <br /> application statements are true and correct. <br /> Print Name: -TY b ill A S _J �°,��tl� Signature: Z <br /> Date: <br /> Print Name: Signature: Date: <br /> t <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> .S. <br />