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Hk'h'-Ny-yY b�J : IOJ iHum: tULbum buulm UHNVH tr' UJ . iu; b1U uj6 J /SY ['HLG YI/21 <br /> Assessor's Parcel No.: 023-190-01 <br /> District agrees to indemnify,defend,and hold the undersigned parties harmless from and against any <br /> and all loss, liability, expense, clauns, 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 /> { <br /> By: Owner signature:_ U <br /> Name <br /> Real Estate Representative r <br /> Owner name: _`�.�v i c, ��✓�� <br /> Date: Please print <br /> Date: to <br /> APP •D BY: <br /> 4 <br /> Stephen J. Boeri <br /> Manager of Real Estate Services <br /> Date: / 1 r SC . <br /> ------------ - -- - - - - - - - -- - ------- - -- - -- - -- -- --- - --- - - -- - - - - - - - - ---- - <br /> Owner. Please complete the following <br /> 1. Please list any spcci:l conditions we should observe while on your property: <br /> 2_ Owner telephone no.: <br /> 3. If you have tenants or lessees on the rcferer 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 />