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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> 7involvodlin'this <br /> HE OWNER.OF THE PROPERTY ORAN AUTHORIZED AGENTMA YFILE AN APPLICATION. <br /> Agent agree, to defend,lndemn/ly,and hold harmless the County and Its agents,of/cam and <br /> rom any claim,action or proceeding against the Owner/Agent's project. <br /> rtify under penalty of perjury that I am(check one): <br /> operty owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s) <br /> is appllcetlon,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 f"Oing ppl/cation statements <br /> are true and correct <br /> Pdnt Name: /Jyi.� l L I, S/gastem. i }� <br /> Data: <br /> Print Name: Slgnsture: Data: <br /> Print Name: Slgnatura: <br /> Date: <br /> PHW Nam.: slpneture:, Deta: <br /> Mnl Namal alenawnl Dam <br /> 1 <br />