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Rug Ol 03 03 : Slp SJC COMMUNITY DEVELOPMENT 2094663163 p_ 7 <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES - <br /> O <br /> NLYTHEOWNER OF THE PROPERTY OR_AN AUTHOR/ZED AGENT MAY F/LE AN APPLICATION, <br /> wner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> ees from any claim, action or proceeding against the Owner/Agent's project. <br /> er, certify under penalty of perjury that I am (check one): <br /> gal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> d in this application, or <br /> gal agent(attach proof of the owner's consent to the application of the property's Involved In this <br /> tion and have been authorized to file on their behalf., and that the foregoing application statements <br /> and correct,me: ✓��A ( I L'(�A _ "gnat e: Date: 6/ /0 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: - Signature: Date: <br /> Print Name: _ -Signature: - Date: <br />