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R <br /> . I <br /> it <br /> ,r <br /> APPLICATION -' SITE APPROVAL <br /> EE 7777 AUTHORIZATION SIGNATURES <br /> rapreptrue <br /> LY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATI <br /> ner/Agent agree, to defend, indemnify, and hold harmless the County and Its agents, officer <br /> es from any claimi action or proceeding against the Owner/Agent's project. <br /> r, certify under penalty of perjury that 1 am (check one): <br /> al property owner(owner includes partner, trustee, trustor, or corporate officer) of the prope <br /> in this application or <br /> II <br /> al agent(attach proof of the owner's consent to the application of the property's involved in <br /> on and have been authorized to file on their behalf., and that the foregoing application statements <br /> nd correct. <br /> I <br /> ;M <br /> Print Name: vEIQ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: i Signature: Date: <br /> I�Print Name: Signature: Date: <br /> Print Name: �. Signature:— – ,. --- g Date: <br /> I�. <br /> I <br /> I <br /> :I <br /> �I <br /> I <br />