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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> : <br /> ONL`YTTHE 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 /> I, further, certify under penalty of perjury that I am (check one): <br /> 0 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 /> applIcatlon and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: 1 <br /> Signature: <br /> Print Name:.2'--21 Date: <br /> 9a GI��in� Signature: ,e.�..-•:. -/2-0/,0-3Print Name: Su�btJNE �.�- Date: <br /> Signature: <br /> Print Name: Date: 3 D� <br /> Slgnatur . <br /> lir/n►Nwnrwl Date: <br /> olpnwt rot <br /> Patel <br />