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WJ ;W2 kKum :ruLDUm bUUln VHIVHL ['rtVJ LV- , LO OJL d /6< t-Mlrn {.7/ Z1 <br /> RECEIVED <br /> 0 DEC 111395 0 <br /> T Assessor's Parcel No.: 023-I50-14 E <br /> Wma SUPPLY NPFOVEMDn <br /> ]Dict agrees to indemnify,defend,and hold the undemgned parties harmless from and against any <br /> and all loss, liability, expense, a ims, costs, suits, damages (including punitive damages), and <br /> attorney's fees, arising directly out of the District's negligent operation or pecfiormance under this <br /> Permit <br /> EAST BAY MUNICIPAL UTILITY OWNER_ <br /> DISTRICT("DISTR.ICT") <br /> RECOi1�1ENDID B : '3`f h <br /> Sy Owner sig4matrrre:_� . <br /> Name <br /> Real Estate Represemative <br /> Owner came: <br /> Date- Please print I� <br /> Date:_T( Vj <br /> APr BY: <br /> Stephen J. Boeri <br /> Manager of Real Estate Services <br /> Date: <br /> ---------------- ----------- --------- ----------- - ------------------ <br /> Owner: Please complete the following <br /> 1. Plessu list any spacial conditions we;shoWd observe while on your property: <br /> Z Owner teleplwae no.: I.(? <br /> 3_ Ifycw have!mars or les eson therefaeaced property,please complete the following so that we can notify <br /> than prior to field activities: <br /> T=altnamo(sr <br /> First Nara Iasi Namt <br /> Tenant mailing address: YC� n5 t t30___ <br /> Street Address. City Zip <br /> Teuanttelephoaeno. �),o q — 7 :1 `7 - 6, n2 <br /> r <br /> Please use the back ofthis page ifad&tional space is required <br /> 2 <br /> TOTAL P.05 <br />