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' t <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I <br /> !, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and Its agents, officers and <br /> omployeos from any claim, action or procooding against tho Ownor/Agont's project. <br /> //, Ihor, cortlfy under ponalty of porjury that I air, (chock ono): <br /> gal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> O Legal agent(attach proof of the owner's consent to the appllcat/on of the property's Involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature: <br /> Date: p <br /> Print Name: _ . O-Y\Q- QGA� 5 Signature: <br /> Date: [�i <br /> Print Name: Signature: <br /> Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: <br /> Date: <br />