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h <br /> f4 <br /> APPLICATION - SITE'APPROVAL <br /> AUTHORIZATION SIGNATURES r . k <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 4, r <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its.agents, officers and ..w .N <br /> employees from any claim, action or proceeding against the Owner/Agent's project. Jil <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) 1 :,} <br /> 'Xinvolved in this application, or <br /> 4 r a <br /> © Legal agent(attach proof of the owner's consent to the application of the property's involvedin thisµ z;' , 1. <br /> application and have been authorized to file on their behalf., and that the foregoing application statements'"':"=" <br /> are true and correct. <br /> n � I_ <br /> Print Name: C�rG�`P� 1C'traCJ� Signature: Date:1 •a= �31 � <br /> t.. :, <br /> Print Name: Signature: �"Dates <br /> Print Name: Signature: Date: - u' <br /> Print Name: Signature: Date:_ <br /> Print Name: Signature: Date:, +-• r- ° <br /> ' .,•- .-..,ter-p:-x,-..�r.,: _ �y; 1 <br /> n l <br /> ' . :,_8 � -- it'. - � t• .t. �l r.rY+i��.�.afk rL{:;� <br /> .. -. � ,. ...nab `•4�,,. <br /> A <br />