Laserfiche WebLink
APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> 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 /> C Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> IB 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: Philip C. Hawtirt Signature: <br /> _L' — trlmn_ Date: 11 -6-96 <br /> Print Name: Signature: <br /> Date: <br /> LPfint <br /> Name: Signature: <br /> Date: <br /> Name: Signature: <br /> Date: <br /> i <br /> Name: Signature: <br /> Date <br />