Private Property Release Form printable pdf download

Private Property Release Form

PROJECT NAME

Contract / EWO No. ____________

Private Property Release Form

To:

Nevada Irrigation District

1036 West Main Street

Grass Valley, CA 95945

Re:

APN(s) __________________, __________________, __________________

As owner of the above referenced parcel(s), I (we) hereby accept any and all responsibility and liability

for the use of the referenced parcels(s) by the Contractor known as

for the purpose(s) of (describe activities completely)

I (we) understand it is my/our responsibility to obtain any permits for the disposal of material upon the

referenced parcel(s) by the Contractor.

Furthermore, I (we) hereby relieve and release the Nevada Irrigation District of any and all responsibility

or liability for the above described uses.

Print Name _________________________________________

Signed ____________________________________________ Date _____________________

Private Property Release Form