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Master Land Use Permit Application <br />Updated October 2021 Page 4 of 4 <br />By affixing my signature hereto, I certify that I am the owner, or am acting as the Owner’s <br />authorized agent*, and that the application and documents contained with this submittal are <br />complete and accurate to the best of my knowledge and abilities. <br /> <br />If your title report lists a company, partnership or other owners, you must submit evidence that <br />you are authorized to sign on behalf of the entity or others that are listed. <br /> <br />Please attach additional signature sheets if there is more than one owner. <br /> <br />Under penalty of perjury, I certify that the information, statements, answers above regarding <br />the subject application(s) are true and correct to the best of my knowledge and belief. <br /> <br />Property Owner Signature: ___ <br />Printed Name: _______________________________________ <br />Date: __________________ ______________________ <br /> <br />Authorized Agent Signature*: __________________________________________ <br />Printed Name: ____________________________________________ <br />Date: ____________________________________________ <br />*If you are an authorized agent (and not the property owner) you must submit a signed, notarized <br />Agent Authorization Form. <br /> <br /> <br /> <br /> <br />