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APPLICATION - SITE APPROVAL <br /> 7HE <br /> ZATION SIGNATURES <br /> ONLY THE OWNER 0f TR AN AUTHORIZED AGENT MAY FILEAN APPLICATION. <br /> I, the Owner/Agent agree, to defenhold harmless the County and its agents, officers and employee <br /> 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 <br /> property(s) involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involve( <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 /> w lJ ✓Z �7 <br /> Print Name: �-t► Va Signature: r, <br /> Date: 9 / <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br />