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11 23-'98 MON 16: 4.3 FAX 6028697217 LARRY LITWILER <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES - <br /> ONLY THE 011VNER OF THE PROPERLY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjurl that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the propemy's involved <br /> in this application and have been authorized to file on their behalf., and that the foregoing <br /> application statements are true and correct. <br /> i <br /> L L�rL,�i"t Date: �Z 3�58 <br /> Print Name: Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Bate: <br /> Print Name: Signature: pate: <br /> i <br /> Print Name: Signature: Date: <br /> L <br />