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APPLICATION - SITE APPROVAL <br /> F' AUTHORIZATION SIGNATURES <br /> • 4 <br /> T-' <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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, 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 /> ;U <br /> 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 <br /> ;: g g application statements <br /> tr are true and correct. <br /> L / , <br /> Print Name: -1�_1)H 1'+ � /L Signature: /l�C ,�� Date: <br /> c <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> y . <br /> Print Name: Signature: Date: <br /> 4.. <br /> r•} <br /> l <br /> 1r <br /> 4., <br />