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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE ANIthis <br /> N. <br /> /, the Owner/Agent agree, to defend, Indemnify, and hold harmless the County and its agend <br /> employees from any claim, action or proceeding against the OwnerlAgent'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) oty(s) <br /> Involved In this application, or <br /> 0 Legal agent(attach proof of the dwner's consent to the application of the property's Iis <br /> application and have been authorized to file on their behalf., and that the foregoing applicents are <br /> true and correct. <br /> a� I <br /> ��b�'l �A"�G Signature: , ;,�,,"` �7n- Date: <br /> Print Name: D <br /> Print Name: Signature: Date: <br /> IJ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Nome: Signature: Date: <br /> i <br />