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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION 15IGNATURRS <br /> ONLY THE.OWNER: THE:PROPERT`l OR AN AUTHORIZED:AGENT MAY FILE AN APPLICATION. <br /> I, theiavawr(Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <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 /> 2 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: John T. Ivancovich Signature: u Date: 1 /2/98 <br /> 1; <br /> Print Name: for Trical.inc. Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -5- <br />