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s <br /> APPLICATION - SITE APPROVAL <br /> AUTHDRlZA1ON''SIGNATURI-S <br /> ONLY THE OWNER OF THE OROPERTYI Oil:ANI AUTNCRIZ D AGENT-MAY#ILEAN APPL1CATiONI <br /> k 1, the OwnerfAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claire, action or proceeding against the Owner/Agent's project. <br /> 3,further, certify under penalty of perjury that I am (check one): <br /> 1 ' Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of the <br /> propetty(s) involved in this application,or <br /> C Legal agent(attach proof of the owner's consent to the application of the property's involved <br /> in this application and have been authorized to file on their behalf.,and that the foregoing <br /> application statements are true and correct. <br /> Print Name: --AR a7`�/ f' Signature: �- Date- /0-,72-9,T�„ <br /> Print Name: Signature: pate: <br /> Print Name: Signature: Date: <br /> f Print Name: _.. _ _ Signature: Date: i <br /> Print Name: Signature: —_ -_--- _ _ Date: <br /> r <br /> i7��-.wyn.�. <br />