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I <br /> ti <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION`SIGNATURES <br /> ONLY THE OWNER'.OF THE'PROPERTY OR:Af4 AUTHORIZED:.AGENT MAY FILE AIV: APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employ( <br /> from any claim, action or proceeding against the Owner/Agent's project. i <br /> I,further, certify under penalty of perjury that I am (check one): Ill <br /> 0 Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> ER Legal agent (attach proof of the owner's consent to the application of the property's involvE <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: Pb i 1 i pr' 14awt i n Signature: Date: 1 1-6— <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> I <br /> I <br />