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08/06/87 11:01 10510 656 1900 SECURITY CAPITAL - 1 <br /> 9E/06/1997 10:17 002 <br /> TSH <br /> �..► TSH -RCHI7EC7S P4G'E 92 <br /> APPLICATION - SITE APPROVAL <br /> J ONLY THE C)WNER OR <br /> "0*'"0"90"a A.�'�+ <br /> 9 gree,to de/end,indemn' <br /> trom any clatm,action or proceedin a d t and hold ham+teas the County and its agereta, <br /> 0 9alnst the 0*—JAgenty arofact. otTleers and erre <br /> I,turtteer, certfry under pbYeet� <br /> penatty of penury that I em(chaclt orae}; <br /> L*W <br /> Pro""" <br /> re i p apInvp bred n th(owner+M�s Partner <br /> ,tnsatw.trvsYor,ore o <br /> �nYl 1 e apW10CIMM,ar °� rate ot:]gr}of he e <br /> II <br /> Legal agent W !attach proal of theL <br /> 7i If?thin appIkotlon and have owree��consmnt 20 the applleetlop of the property's Involved <br /> aoPNtation statarfs♦nts ara true arta*M- tO Me on their bey • and th.&I the fongavOl <br /> � Pont N <br /> ��'� SIQnNune <br /> Print Name; per_�. <br /> Pr!n t Name: 3 fpna <br /> Der: <br /> slanature; <br /> I �nrntwnr.: oma: <br /> Drint Name; SlOnatrrra: �— <br /> Dets <br /> Data: <br />