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APPLICATION - SITE APPROVAL <br /> : . <br /> A[lTtAORlATION:.S. GNaTUREs: <br /> > ,tS,. .:.. ... ..� . <br /> f ONLY THE:OWNER'Of= THE.FsROP.Ef7TY,dR Ai�>'AUT ' t]RIz> IJ"AGEfVT MAY::FiI_E:'AN <br /> I, ilia Owner/Agent agree, to defesid, Indemnify, and hold harmless the County and its agents, officers and ernpioyees <br /> from any claire, action or proceeding against (lie Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> El Legal property owner(owner includes partner, trustee, (rustor, or corporate officer) of the <br /> property(s) involved In this application, or <br /> xWc Legal agent (attach proof of tine owner's consent to the application of the property's involved <br /> In this application and have been authorized to file on their behalf., avid that the foregoing <br /> application statements are true and correct. <br /> -4Print Na nie IV N« Siy� <br /> gnature: N�'"�l' Date: z <br /> PfInt Name: Slgnalure: Date: <br /> Print Narne: Signature: hale: <br /> Print Narne: Signature, Dale: _ <br /> Print Name; Signature: Bale: <br /> i <br /> i <br /> i <br /> i <br />