APPLICATION SIGNATURES
DECLARATION:
I hereby declare under penalty of perjury that this application and all information submitted as part of this application is true
and accurate to the best of my knowledge. I am the owner of the subject property or have been authorized in writing by the
owner(s) of the subject property to represent this application, and I have obtained authorization to submit this application
from any other necessary parties holding an interest in the subject property. I understand it is my obligation to obtain such
authorization, and I further understand that TRPA accepts no responsibility for informing these parties or obtaining their
authorization. I understand that should any information or representation submitted in connection with this application be
inaccurate, erroneous, or incomplete, TRPA may rescind any approval or take other appropriate action. I hereby authorize
TRPA to access the property for the purpose of site visits. I understand that additional information may be required by TRPA
to review this project.
Signature:
At Date: _____
Owner or Person Preparing Application County
AUTHORIZATION FOR REPRESENTATION:
Complete this section only if an agent or consultant is submitting this application on behalf of the property owner.
The following person(s) own the subject property (Assessor’s Parcel Number(s) ) or have
sufficient interest therein (such as a power of attorney) to make application to TRPA:
Print Owner(s) Name(s):
___________________________________________________________________________________________
___________________________________________________________________________________________
I/We authorize to act as my/our representative in connection
with this application to TRPA for the subject property and agree to be bound by said representative. I understand that
additional information may be required by TRPA beyond that submitted by my representative, to review this project. Any
cancellation of this authorization shall not be effective until receipt of written notification of same by TRPA. I also understand
that should any information or representation submitted in connection with this application be incorrect or untrue, TRPA may
rescind any approval or take other appropriate action. I further accept that if this project is approved, I, as the permittee, will
be held responsible for any and all permit conditions.
Owner(s) Signature(s):
Date:
_______ Date:
FOR OFFICE USE ONLY
File Number: ____ ______________
Date Received: Received By:
Filing Fee: $ ________ Receipt No.: ____ _____________
