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• UPISAV <br /> AomomZiir6N SIGNATURES. <br /> ONLY THE OWNER OF THE'PROPERTY'OR AN AUTHORIZED AGF_NT MAYPILE AN'APPOCAT10N, <br /> +I the OwnWAgent agree,to defend,indemnify,and hold harmless the County and its agems,officers and em <br /> claim,action orproceeclng against the OwnedAgenYs project. ice!cos Iroen any <br /> 4 further, certify under penalty of perjury that l am(check one): <br /> Legal property owner(owner Includes partner,trustee,hvstor,or corporate officer)of the property(s) <br /> involved in this application,or <br /> U Legal agent fattach proof of the owneris consent to the app rwa*m of the property's involved in this <br /> application and have been authorized to file an thafrbeha" <br /> and that the foregoing application statpnents are tree and correct <br /> Print Name: J • +OMAtti <br />` Print Name: Signahr Date: <br /> Print Name: Signature: Date; <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Afountarn HouseNHApplication FormsllWi-tdlP-SA4Pkrm-MASTER.doc <br /> APPROWD <br /> TYSEEs <br /> This COAMUy RVD1S <br /> 1-RfCT8pprav3laxir�nds <br /> only tp that e <br /> P5 shown and d,-,cc C.._? t;. <br /> doas not atithorlr ;-. ri5 pian, <br /> dev"a-U-O'n O r ] r-t any arrTgS$A3nC6' <br /> 1 zti A.t1 <br /> agar cies fa r- <br /> ��' vrls, <br /> Date; <br />