Form CalRecycle741 "Property Access Authorization and Non-responsibility Affidavit for Private Property" - California

What Is Form CalRecycle741?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CalRecycle741 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle741 "Property Access Authorization and Non-responsibility Affidavit for Private Property" - California

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Department of Resources Recycling & Recovery (CalRecycle)
State of California
CalRecycle 741 (Rev. 2/18)
Print
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Property Access Authorization and Non-Responsibility Affidavit
For Private Property
I,
certify that I am the legal owner, or authorized
agent of the legal owner, of the property located at the following address:
and have the authority to grant access to the property. Neither I, nor any resident,
invitee, licensee, lessee or person I inherited from, personally brought any of the
subject waste tires onto my property. Nor did I, or any of the above, direct, authorize,
permit or otherwise provide consent to another to bring the tires on my property.
Specifically, to the best of my knowledge the circumstances of how the tires were
brought onto my property, and the manner in which I became aware that the tires
were on my property, are as follows:
I hereby authorize the City or County representatives applying named
their designated contractors and representatives and other state and local agencies
authorized to access the property described below for the purpose of removing tires.
This cleanup is being performed under the Local Government Waste Tire Cleanup
Grant Program.
I understand that by signing authorization to access the property, I am not admitting
liability or responsibility for the cleanup of the property.
I declare, under penalty of perjury, under the laws of the State of California, that all
the above information is true and accurate to the best of my knowledge and belief.
Name of Property Owner
Signature of Property Owner
Address
Parcel Number
Date
Telephone Number
Parcel Zoning
Department of Resources Recycling & Recovery (CalRecycle)
State of California
CalRecycle 741 (Rev. 2/18)
Print
Clear
Property Access Authorization and Non-Responsibility Affidavit
For Private Property
I,
certify that I am the legal owner, or authorized
agent of the legal owner, of the property located at the following address:
and have the authority to grant access to the property. Neither I, nor any resident,
invitee, licensee, lessee or person I inherited from, personally brought any of the
subject waste tires onto my property. Nor did I, or any of the above, direct, authorize,
permit or otherwise provide consent to another to bring the tires on my property.
Specifically, to the best of my knowledge the circumstances of how the tires were
brought onto my property, and the manner in which I became aware that the tires
were on my property, are as follows:
I hereby authorize the City or County representatives applying named
their designated contractors and representatives and other state and local agencies
authorized to access the property described below for the purpose of removing tires.
This cleanup is being performed under the Local Government Waste Tire Cleanup
Grant Program.
I understand that by signing authorization to access the property, I am not admitting
liability or responsibility for the cleanup of the property.
I declare, under penalty of perjury, under the laws of the State of California, that all
the above information is true and accurate to the best of my knowledge and belief.
Name of Property Owner
Signature of Property Owner
Address
Parcel Number
Date
Telephone Number
Parcel Zoning