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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> 0NLY'THE!OWNER OF.THERROPERTY OR ANAUTHORIZED RIZED AGENT MAY FILE AN APPLICATION. <br /> the Own <br /> F/, eNAgentent agree, to defend, Indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claim, action or proceeding'agalnst the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that/am (check one): <br /> XLegal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s,i <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 file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> a <br /> Print Name: <br /> : <br /> Print Name: <br /> Signature: Date: E <br /> Print Name: Signature: ) <br /> dHl+1fVDate: I 3 <br /> Print Name: S/pnaturo: <br /> PMM Noma) Dotal <br /> a/pnaturof potol ....�. <br />