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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION. SIGNATURES <br /> ONLY THE.OWNER.OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> 11 I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employee: <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> II, 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 /> I property(s) involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property'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 /> Print Name: Signature: -Date: Z - I (7 `?7 <br /> o W"&A— <br /> Print Name: 177dlf <br /> u� ^) Signature: — � Date: Z-/0 -5 <br /> pw0--f2 -� <br /> Print Name: �'�P'✓L-I LU •(�/ Signature: L.�� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br />