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Jul-18-00 01 :06P P.05 <br /> r.. <br /> APPLICATION - SITE APPROVAL <br /> AUTHOPUATION SIGNATURES <br /> ONLY TH4 OWNER OF TH-F PRQPERTY OR AN AUTHORfZEf.1 AGENT MAY FME AN APPLICATION, <br /> 1,the OwnedAgent agree;to dofend,Indemnity,and hold harmless the County and Its agents,officers and <br /> employees front arty Claim,action er proceeding against the Owner/Agent's project. <br /> I,further; certify under penalty of perjury that I am(chock one), <br /> � I <br /> Legal property owner(owner inc►trcfes partner,trusted,trustor,or corporrte ofncerl of the property(s) <br /> Mvaived in this application,or <br /> El Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been atrthorfzed to file on thefrbehrilt.,and that the foregoing application statements <br /> are true and correct <br /> Print Mama: 1�I�tctllL} � 1� i� S)gnafere: +._ Dater 13 Of <br /> Pant Mame: Signalurw Date. <br /> Pant Name: Signature: Date. <br /> Prrnr Nance-, Signanrre, Dater <br /> Prim Name: Signature: Pare: <br /> 1 .v <br />