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r.rrt-r'.�-.� . oma . .... r.�...... .......... ......... .•....r... ....... . ... . .. ... ....� .. . ..� . . ...... . ., �. <br /> Assessor's Parcel No. 152-250-30 and 154100-20 <br /> District agrees to indemnify, 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 /> RECOMMENDED BY: <br /> By: Owner signature4 (/y,V(,t� <br /> Name / <br /> Real Estate Representative Owner name:WgA/f�„L 11Z7CJZ f <br /> Please print <br /> Date: Date: X6-1 <br /> APP VF-D BY: <br /> Stephen r_ Boeri <br /> Manager of Real Estate Services <br /> Date: <br /> -------- - - - - - - - - - - - -- - - - - -- ----- -- - - -- - -- --- - - - - - - - - - - - - - - - - - - -- - - <br /> Owner Please complete the following <br /> I. Please list any special conditions we should observe wh <br /> ile on your property: <br /> 2. Owner tVlephone no.: ( C / L- — C' J A 6 7 <br /> 3. Ifyou have twants or lessees on the refemrced 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 /> 11 <br />