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APPLICATION! - SITE APPROVAL <br /> AUTHORIZATION SIGNATURES: <br /> ONLY THE OWNER OF THE PROPERTY ORAN AUTHORIZED AGENT MAY FILEAN'APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and (told harmless the County and its agents, officers and employees <br /> from any claire, 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 /> L]"' 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 true and correct. <br /> —77 <br /> Print Name: _J t��EL I,yy )Irlj Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -s- <br />