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AVM-WW-J/ iOH; 02 kkCUM=kULSUM SUUIM LANAL ['KUJ . 1U= 511U tl.3G Jl3G rNUt. 11111 <br /> 10:-79'�s 1o: l9 FAX 51n ^: 1273 EBMT I)(IQ <br /> 1 <br /> Assessor's Parcel No.: APN 023-140-012 <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 (ineWing punitive damages), and attorney's fees, <br /> arising directly out of the District's negligent operation or performance under this permit. <br /> EAST BAY NI( 7CLPALUTIT..ITY O%VNER: <br /> DISTRICT("DTSTRTCT") <br /> RECO- <br /> ED BY <br /> By: V a� Owner signature: <br /> Paul C.Voover <br /> Real Estate Representative <br /> l �( r Owner name: tx a <br /> I Pleue prnrt <br /> Date: 1 � ll(� pate_ <br /> APP •D BY: <br /> V V tephen J. BOeri <br /> Manager of Real Estate Services <br /> Date: U LV 16 <br /> - - - - - - - - - - - - - <br /> Owner- Please complete the following <br /> I. Please Iist any special conditions we should observe while on your property: <br /> 2. Owner telephone no.: <br /> 3. If you have Tenants or lessecs on the referenced property, please complete the following sn that we can <br /> notify thein prior to field activities: <br /> Tenant nanle(s): <br /> First Dame Last tvame <br /> Tenant mailing address <br /> Street Address City lip <br /> Tenant telephone no. <br /> Please use tke back of!his page ifaddit-4Xl spare ZS regTored <br />