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fit.. <br /> APPLICATION - SITE APPROVAL <br /> .. ;,>, ;•,+. .k:.t^>. :sax. .- } :;:�s; :LS s fi {:: <br /> .w�'�x. >�, s -xs�,,# �ytc� .et;�3;�::' :i -�k-S .;��.� r ;• �-{ e.,, { <br /> ONLY TM OWf�ER'Of'. Hi PROP.•EftY : ,: I11�Ht]�fz�D.�G�NT. :APP�IGATIDN 2..............:: <br /> I, the OwnerlAgent 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 /> p Legal property owner(owner includes partner,trustee, trustor, or corporate officer) of the <br /> property(s) Involved In this application, or <br /> x10 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 loregoh+g <br /> application.stateme-nts are true and correct. <br /> I , <br /> Print Name: KEN CLEMENT signature- Date: 11/10196- <br /> Print <br /> 1/la/96Print Name: signature: Date: <br /> r <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i t . <br /> j' <br /> S a <br /> . s r <br /> i <br /> , .- .._ _ ..� ..... ..�•'.+. .i s. �a�.�;ar—.as.:e..�.y.-.we•+nwrr..�u.r <br /> `q* <br /> I <br /> DRi � <br /> E <br /> {'r <br /> i I <br />