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j <br /> i APPLICATION - SITE APPROVAL <br /> AUTHORIZATION:SIGNATURES <br /> ONLY THE O WNER Q THEPRORERTY OR AN A UTHORIZED AGENT MAY FILE AM APPLICATION, . <br /> 11 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 Owner/Agent's project. <br /> 1, further,,certif-underpenalty_ofpe pry_lhat.l_am_(check_one) ._ . <br /> Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Involved In this application, or i <br /> 0 Legal agent(attach proof of the owner's 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 /> i <br /> are true and correct. <br /> Print Name: p -pL-J Signature: Date:�LSZ <br /> Print Name: C � �(XJf 15 Slgnatu Date: �6 _ <br /> i - <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name; Signature: Date: <br /> i <br /> � I <br /> I <br /> II� Ili <br /> I <br /> e <br /> i <br /> �i <br />