[StBernard] Right of Entry Permit Form - Text Version

[Westley Annis]

RIGHT OF ENTRY AGREEMENT FORM

 

 

I/We__________________________________________, the owner(s) of the property
commonly identified as____________________________________________________,

                                                           (street)

______________________________, ___________________________, State of______

              (city/town)
(parish/county)

do hereby grant and give freely and without coercion, the right of access
and entry to said property in the County/Parish/City
of_____________________________, its agencies, contractors, and
subcontractors thereof, for the purpose of removing and clearing any or all
storm-generated debris of whatever nature from the above described property.

 

It is fully understood that this permit is not an obligation to perform
debris clearance. The undersigned agrees and warrants to hold harmless the
County/Parish/City of,

_______________________, State of ________, its agencies, contractors, and
subcontractors, for damage of any type, whatsoever, either to the above
described property or persons situated thereon and hereby release,
discharge, and waive any action, either legal or equitable that might arise
out of any activities on the above described property. The property owner(s)
will mark any storm damaged sewer lines, water lines, and other utility
lines located on the described property.

 

I/We (have ______, have not______) (will_______, will not_______) received
any compensation  for debris removal from any other source including Small
Business Administration (SBA), National Resource Conservation Service
(NRCS), private insurance, individual and family grant program or any other
public assistance program. I will report for this property any insurance
settlements to me or my family for debris removal that has been performed at
government expense. For the considerations and purposes set forth herein, I
set my hand this _______ day of ______,  ______.

 

 

 

 

______________________________
_______________________________

 Witness
Owner

 

 

 
_______________________________

 
Owner

 

_______________________________

 

_______________________________

 

_______________________________

Address and Telephone Number

 

 

 

 

 

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