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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION:SIG NATURES >' <br /> ONLY THE OWNER OF THE PROPERTY ORAN AUTHORIZEII 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 <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> rW Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf.,and that the foregoing <br /> application statements are true and correct. <br /> Print Name: l/V//,,j„JA/o j4 14/x,)S o Signature: � A'. Date: -7 '0 <br /> Print Name: Signature: L ✓ Date: 7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />