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APPLICATION .. SITE APPROVAL <br /> A'UTHORIZATlON,:SlGNATUI4ES <br /> r <br /> ONLY-THF <br /> f OWNER OF THE'PROPERTY OR AN AUTHORIZED'AGENT M <br /> AY FIDE <br /> - .. AN..:APPLICATlON ..:.. ".. <br /> 1, the OwnerlAgent 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 /> F <br /> J, further, certify under•penalty of perjury that 1 am (check one): <br /> © Legal property ownerowner includes s partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> f rare <br /> al agent(attach proof of the owner's consent to the application of the property's involved in this <br /> ion and have been authorized to file on their behalf., and that the foregoing application statements <br /> and correct: <br /> e: J �C4J &.4CK, Si nature:g Dafe: T. r$� O 3 <br /> e: Signature: Date: <br /> e: Signature: pate: <br /> e: Signature: Date: ; <br /> Print Name: Signature: . Date: ^ <br /> I <br />