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Assessor's Parcel No.. 152-100-50 <br /> District agrees to indenuady,defend, and hold the undersigned parties harmless from and against any <br /> and all loss, liability, expense, claims, costs, suits, damages (including punitive damages), and <br /> attorney's fees, arising directly out of the District's negligent operation or performance under this <br /> permit. <br /> EAST BAY MUNICIPAL UTILITY OWNER: <br /> DISTRICT ("DISTRICT') <br /> RECOMM]EENDED BY.- <br /> By: Owner signature: , /J7 vL <br /> Name <br /> Real Estate Representative / <br /> Owner name: r: rr7rrS-tz� ��UcJf=S <br /> Date: Please print <br /> Date: ; ) <br /> .APP <br /> �ItOi ;VtE/D BY_ <br /> Stephen J. Boeri <br /> Manager of Real Estate Services <br /> Date: <br /> Owner. PIease complete the following <br /> I. Please list any special conditions we should observe while on your property_ f c C <br /> J t: r <br /> 2. Owner telephone no-: �<•x� �./• - ,t7 ri/ ,('c' °'' �:�„ � t,r f <Wc[y, ,. <br /> f <br /> 3. if you have tenants or lessees on the ref=iced property,please complete the following so that we can notify <br /> them prior to field activities: <br /> Tenant name(s): <br /> First Name Last Name <br /> Tenant mailing address: <br /> Street Address City Zip <br /> Tenant telephone no. <br /> Please use the back of this page if additional space is required <br /> 2 <br />