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APPLICATION - SITE APPROVAL <br /> � s, _- <br /> UTHORIZATION SIGNATURES <br /> ......:.. S f ......:.$ .......-:. S <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> I,the Owner/Agent agree,to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees 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 /> ❑ Legal property owner(owner includes partner,trustee,trustor,or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements are <br /> true and correct. <br /> Print Name:),,iC G,Ahd 41&JCLj2 Signature: Date. <br /> Print Name: _e�r L_ 17.�.✓a��[rD Signature: Date: k <br /> Print Name: TOG f► n-e- Do nd-- ro Signature. n ate: <br /> Print Name: r /'/_ � N.l�� Signature. P1—,&- x . '• .�mr�a.� —. <br /> Print Name: Signature: Date: , <br /> •451. <br /> f <br /> f: <br /> ! r <br /> ,1 J <br />