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J <br /> q <br /> APPLICATION - SITE APPROVAL <br /> ONLY THE OWNER OF THEPROPERMOWAWAUTF mumP <br /> 1,the OwnedAgent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and empbydes <br /> from any claim,action or proceeding against th0 OwnerfAgent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> M Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the <br /> property(s)invohred 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 aro true and correct. <br /> Print Name: i.�.l Yn 1)I�) , �J- Signature: ate: .Z 7 <br /> Print Name: DP,��G� R. i1r1� �� Signature: Data:-7- - <br /> Print Name: Signature: Data: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -s- <br />