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UP/SA/IP <br />I AUTHORIZATION SIGNATURES I <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 employees from any <br />claim, action or proceeding against the Owner/Agent's profect. <br />I, further, certify under penalty of perjlry that I am (check one): <br />xLegal 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 owners consent to the application of the property's involved in this <br />application and have been authorized to file on their behalf) <br />and that the foregoing application statements are true and correct. <br />~~/fl/QIUV <br />Print Name: Craig Mazzara Signature: Date: 11-18-21 <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Mountain House\MH Application Forms\MH-UP-SA-IP form-MASTER.doc <br />-8-