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r�r.c-via-ar qua : nn rrc�u .r.a..�.... o....... ..r...r,.. . ....... . .... . ..... .:..,� .. ..� r..... ..,. �. <br /> 41. <br /> Assessor's Parcel No.: 009-080 • <br /> District agrees to indemnify,defend,and hold the undersigned parties harmless from and against any and <br /> —� all loss, liability, expense, claims, costs, suits, damages, and attorney's fees, arising directly out of the <br /> District's negligent operation or performance under this permit. <br /> EAST BAY MUNICIPAL UTILITY OWNER: <br /> DISTRICT("DISTRICT") <br /> RECO ENDED BY: / l <br /> By 111Ad Owner signature: <br /> Jan Rogers <br /> Real Estate Representative <br /> Owner name: <br /> Date: �.0/�!.• aC 2•��-.-+jjr' <br /> Please print <br /> Date: <br /> APPR,PYED BY- <br /> 9 <br /> tephen J. Boen <br /> Manager of Real Estate Services <br /> Date: l( 4-wt <br /> --- - - --- - - -- - - - - -- - - - - - - - - - ---------- --- ---- - ---- - -- - - - -- - - -- - - - -- <br /> Owner: Please complete the following <br /> 1_ Please list any special conditions we should observe while on your property: <br /> 1 Owner telephone no-: <br /> 3. If you have tenants or lessees on the referenced property,please complete the following so that we can <br /> notify 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 a required <br /> �-1 <br /> 76160.11 2 Re,. 11106/96 <br />