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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwnerlAgent agree, to defend, Indemnify, and hold harmless the County and Its agents, oKlcers and <br /> employees from any claim, action or proceeding against the Ownor/Agont's project. <br /> 1, further, certify undor ponalty of perjury that I ani (check one): <br /> tY Legal property owner(owner Includes partner, trustee, trustor, or corporate officer) of the property(s) <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 /> Print Name: V4//-1/ 7C2 'r WCL✓ Signature: /,yz ��/9f 5c�� Date:C�'- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />