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UPISAMP <br /> AUTHORIZATION SIGNATURES <br /> ONLY 7HE OWNER OFTHE PROPERTY ORANALITHORREDAGENTMAYFILEAN APPLICATION. <br /> 1,the OwneAAgenl agree,to defend,Indemnity,and hold harmless the County and Its agents,officers and employees from any <br /> claim,action or proceeding against the OwnerlAgenrs project <br /> 1,further, comity under penalty ofpeijuiy that l am(check one): <br /> ❑ Legalpmperty owner(ownerincludes parmer,Wstee,truster,or corporate officer)ofthe properly(s) <br /> Involved in this application,or <br /> ❑ Legal agent(attach pruofof Ne owner's consent to the application ofthe properlyY involved in this <br /> application and have been authorized M rile on their bohalo <br /> and that the foregoing application statements are true and correct <br /> Print Name: L l TJ/N , fi IOS Signature: �C Date:'71 <br /> Print Name: �A f/Q'� ry, F.tf05 Signature: Date:'/�/ll(�8 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Mountain HouwVdHApplir tion Form WH.UP-SA-IP Imre-MASTER.doc <br /> A- <br />