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aAn JUAIIWn UUUNI Y "MMUNII Y UtVtLUt'MtNI OLPAMI MtNI <br /> VOW AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penalty of perjury that/am(check one): <br /> Legal property owner(owner Includes partner, trustee, trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved in this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name:,�(l IL/A DI' l`70 IYI a Z— Signature: Date: <br /> Print Name: Signature: J Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 10'.M AMPA_ll.A FWuvy 1.1WR <br /> -4- <br />