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y � V <br /> a,-y1r <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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!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 /> Legal agent(attach proof of the owner's consent bto alf application <br /> the foregoing application staved tements <br /> are <br /> n this <br /> application and have been authorized to file on the <br /> are true and correct <br /> � - nature: Date: <br /> Print Name: Zc5rlrLJJ -4 0C I oF signature.. <br /> r!1►�,?tLA �o vJ �Z Date: <br /> Print Name: Signature: <br /> Print Name; <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> x <br />