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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 I am (check one): <br /> O Lland <br /> erty owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> inapplication, or <br /> t(attach proof of the owner's consent to the application of the property's involved in this <br /> �pplicationhave been authorized to file on their behalf., and that the foregoing application statements <br /> arrect. <br /> Print Name: A,d21LW lT'�S1U� Signature: Dat *c, 03 <br /> e: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature; <br /> Date; <br /> Print Name: Signature: <br /> Date: <br />