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APPLICATION - SITE AQPROVAL <br /> �r.r .ry„ '. ..�.. z _.:_^rrzsrc.=cs `.s ^r �,µw4: T'•rrenrmv.+vh <br /> -AUTHORIZATION SIGNATURES` <br /> 2ch-. p;�,.,•r:-s,,x."+"_.».:.n::"', ".c-amu:. ,,,,. ;:,�'r'�RY' '1�'yw^ <br /> --=ANLY THE OWNER <br /> OF THE PROPERTY OR AN AUTHORIZED AGENT MAY 0-11-F!WAN APPUCATON.x^:,..?;_ <br /> I,the OwnerlAgent 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 /> I,further, certify under penalty of perjury that I am(check one): <br /> ❑ Legal property owner(owner includes partner,tnatee,trustor,or corporate ofr"r)of the property(s) <br /> involved in this application,or <br /> xf,kx Lagar agent(ettech proof W the owner's consent to the application of the property's involved In this <br /> appilc&Wn and have been authorized to fila on their behalf.,and that the foregoing application statements am <br /> true and correct <br /> Print Mama: ROGER LISTON Signature: <br /> Prat Name: Signature: Dab:lll�L: <br /> Print Nana: Signature: Date: <br /> Prid Mama: signature: Date-- <br /> Print <br /> ataPrint Nam: Signature: Dab: <br />