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APPLICATION - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES' <br /> ONLY THE.OWNER OFTHE PROPER TYORAN-AUTHORIZED AGENT.MAY FILEAN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the <br /> property(s) involved in this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the Property's involved <br /> in this application and have been authorized to file on their behalf., and that the foregoing <br /> application statements are <br /> a�re true and correct. <br /> Print Name:� S [�� / 1 �j <br /> // qq 5 <br /> Slgnatur "? / Date: �6 W L & <br /> Print Name: _ S�'Je rvy l Lj�c ��f /./Signatur +� <br /> lj <br /> Print Name: Date: O <br /> Signature. Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: <br /> Date: <br />