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o..-ed Agent May File an Application' <br /> /, the OwnedAgent,agree to defend,Ino._ onlfy,ano hold harmless the County and Its agents,_dcers and employees from any claim, <br /> action or proceeding against the OwnerlAgent's prt Ject. <br /> I further certify,under penalty of perjury, that I am(check one): <br /> O Legal property owner(iwner Includes partner,trustee,grantor,or corporate officer)of the property(s) <br /> Involved in this application,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 Me on their behalf.,and that the foregoing application statements <br /> are true and correct <br /> Print Name: "( 'ill lil( r'l J Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />