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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 Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that l am (check one): <br /> ❑ Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ 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. d that t ore r g applica ' n statements <br /> are true and correct. <br /> _l <br /> Print Name: c U , � (� �uGd Signature: Date:SPiNGOLO <br /> Print Name: V SignaturNK�is- Date: <br /> 1011 N.Broadw�aY�A�venin <br /> Print Name: Signature: 6TOCKT&C CAL MML6,95Z05 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />