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a UJ! UG/1771 ice.GJ GU 7'70G-0101 BGG NJJUIa r-„GJ I-Nl]G UO <br /> laPlUM Ur I_MLlrUM111" aA•Gv:j •.vv <br /> APPLICATION - SITE APPROVAL <br /> i.t.• ' f it 1� �K C!��:�� %>'�.' f.YM' 'pa<,s»v.:r — ..,...;. <br /> .. � } t✓.•. ,1.. .i�.. .k .! .}tjs'u iY,. :,frShVJ<SSC§�::rv:'FyPAA'S..�•��•S,:K�j�:Y.iY:. <br /> • i;=fix•'• .;6,:, :�r�::':«''Y•i> �'-t�dk•+'lis*~.::.iti+:si!'f,��:'i,+re fix i�i <br /> • •a <br /> ---AUTHORIZATION SIG NATURE$;; I<�." <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED A0ENT MAY FILE AN APPLICATION. •.'.•, <br /> I, 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 /> I, further, certify under penalty of perjury that I 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 <br /> O 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 are <br /> true and correct. <br /> Print Name: V\Pt „ ('�)U Signature: J Date:_ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />