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APPLICATION - SITE APPROVAL <br /> FNaR ZATTLIR rh <br /> I{JIYfS .�.�1A 4 s � Y'x"xy,, w5,��' ,,x'y�r,u a• {yti '� & ,� '�'.. <br /> �,ys <br /> ,.. <br /> 7;:ON[.,l7lfE OYf!N . NTI...';� kY1 �1 � �'�`'�ERHDPf1YH <br /> IPPL .4 �CfV . <br /> 1, 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 /> 1, further, certify under penalty of perjury that 1 am (check one): <br /> ❑ Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> L7 Legal agent(attach proof of the owner's consent to the application 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 /> V 1 I <br /> (_A <br /> Print Name: y�J e 11L��J lL/rrJpn/ Signatur Date: <br /> v <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> d <br /> h <br /> s <br />