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APPLICATION SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLYTHE.OWNEROF,THE.PROpFRTY.ORANQUTHORIZED`AGENTMAYFILEAN APPLICAT <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and Its agents, officer and <br /> employees from any claim, action or proceeding.'against the Owner/Agent's project. <br /> '�41�furfher, certify under penalty of perjury:that 1 am_(, heck one): _ - <br /> -- <br /> © Legal property owner(owner Includes partner, trusteetrustor,, or corporate officers of <br /> Involved In this appl/catlon, or the properly(s) <br /> Legal agent(attach proof of the owner's consent to the applicatlon of <br /> applicatlon and have been authorized to file on their behalf., and that the foregoing any llcatlonvs atements <br /> P rPrin <br /> and correct. g g pp <br /> 4 <br /> j me: U pL S <br /> Signature: <br /> e: Date: 2-e--0,3 <br /> Signature: <br /> e: Date: <br /> Signature: `� <br /> e: Date: <br /> r�l <br /> Signature: � <br /> �IClf.tulw7 Date: <br />