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~ �.� ADJUSTMENT <br />/ ~~~~ . �~.~~~ ~.~~,~~~~~. ..~~~~ . <br />� <br />! <br />� <br />� <br /> / <br /> � <br /> � ! <br /> / <br /> | <br /> � <br /> 1,the OwnerlAgent agree,to defend,IndemnIA6 and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the OwnerlAgent's prqfect <br /> 1,furthar, certflyunderpenaftyal'perjury that I am(check one). <br /> 0 Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Invotved In this <br /> application,or <br /> 0 Legal agent(saach proof of the ownees consent to the application of the property's Involved in this application and have <br /> been authorized to 019 an Moir behaff.,and that the"oing application statements are true and correct <br /> Print Name. 'IkUldill ada: Signature. <br /> PHni Name: OCAt Signature; Date: <br /> 61/ <br /> PrInt Name: Signature: Date. <br /> Print Name. Signature: Date: <br /> Print Name: Signature. Date: <br /> " <br /> ........... - ' <br /> � <br /> | <br /> | <br /> | <br /> < <br />