Laserfiche WebLink
— — Apr. 13 2000 02:4y3' lpro0 <br /> FROM : WARDLEY-FILP1 PHONE NO. 1 510 483 8174 <br /> Apr 13 00 07: 34a <br /> APPLICATION - SITE APPROVAL <br /> AUTHORIZA71ON SIGNATURES — <br /> ONLY TME OWNER OF THE PROPE.R7Y OR AN AL THOWYEO AGENT MAY FILE AN a9PL:CAVON. <br /> j r, the owner/Agent agree,to defend,Indemnify,d"d hold na,mless the Countyand its aganfs.al t6/S 1n9 <br /> fI emp;oyees from arty cts+m.&labor'orprocee--4,ngagainst tl?o Owner/Aget:f's protect. <br /> 1.further, cerut/under penalty of perjury that 1 am(Chock on*)-' <br /> _ag.al propar y Owner(ownw,nciudes partner,trUttcc,vustor,or corForatg officer;athCProporty(a) <br /> hivoiWad in this aF?litatior.,or <br /> L tgsr agent(&Hach proof�11`the owner's cons rrrt to the apy.'Icg'.'oa of the property's involved in this <br /> appiiwlio)z arid have been authorized io flue or their bahalf.,9nd that the foragc(ng application srs:c menus <br /> are truc and correct <br /> PrintNeme: T nr r_�,.. _.-.-- S(grtamre: Data:-4i Z-00 <br /> Al- 20 TAM 4-12-00 <br /> signarum A_ _ Date. _ <br /> A A�ntNemu: 57grta4rra: Qat&: <br /> �nnt Nam $i?natUrv: Date: <br /> x Pr;nt Namo: Si9neturo: Dow �; <br />