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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHOR/ZED 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 OwnerlAgnnt's project. <br /> /, further, certify under penalty of perjury that/am (check one): <br /> Ay Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Involved In this application, or <br /> O Legal agent(attach proof of the owners consent to the application of the property's Involved In this, <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: FU ofSeK S �' ', AV <br /> Signature: - Date: 7 3o p3 <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> PHM NoMal Date: <br /> aig"Neurae <br />