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COMMUNITY DEVELOPMENT DEPARTMENT SAN JOAQUIN BUSINESS LICENSE Ak COU i'1TY FILE NUMBER: FOR STAFF US 5 ONLY Response Due Date: EV-2-1 I Business Information Applicant Information Business(DBA)Name: 1hu F_FA-1 �14 F L- 4fV_0 VA m e: i Mailing Address: I Mailing Address: C INV C_"M C-71V Phone: Phone: (W(o) t2cto —�2io,i Email: Llk'A ii la In83 (,*-rn L c, )m _1 V_ V Property Information 01 Ll Assessor Parcel Number Property Address City Cross Street Lty. A(D W-E_bqM0 U. Business Details Description of Business: ............ Type of Organization: El Single Owner Partnership El Corporation ❑ Other: Does the business include the sale of firearms? El Yes No Number of Employees Hours of Operation Water Service Sewer Service Full Time Part TimePublic Private(on-sit ) Public ePrivate(on-site) (+o El 29 AUTHORIZATION SIGNATURES 1,the Owner/Applicant/Agent agrees to indemnify,defend(with counsel reasonably approved by County),and hold harmless the County and its officers, officials,employees,agents,boards and commissions(collectively"County")as follows: 1.INDEMNITY: A. From and against any and all claims,demands,actions, proceedings,lawsuits,losses,damages,judgments and/or liabilities arising out of, related to,or in connection with the application and applied for project or to attack,set aside,void,or annul,in whole or in part,an approval of the applied for project by the County,the adoption of environmental review documents related to the applied for project,and any related development approvals or project conditions for the applied for project(hereinafter"Claim"); B. For any and all costs and expenses incurred by the County on account of any Claim,except where such indemnification is prohibited by law, including but not limited to damages,costs,expenses,attorney's fees,or expert witness costs that may be asserted by any person or entity, private attorney general fees claimed by or awarded to any party against the County,and the County's costs incurred in preparing an administrative record which are not paid by the petitioner. C. Except as to the County's sale negligence or willful misconduct. 2.DEFENSE: A. The County may participate or direct the defense of any Claim.The County's actions in defense of any claim shall not relieve me of any obligation to indemnify,defend,and hold harmless the County. B. In the event of a disagreement between County and me regarding defense of any Claim,the County shall have the authority to control the litigation and make litigation decisions,including, but not limited to,the manner in which the defense is conducted. C. If I fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably satisfactory to the County,then County may utilize the Office of the County Counsel or employ separate outside counsel to represent o defend the County,and I shall pay the reasonable attorneys'fees and costs of such counsel. Print Name: Signature: Date: C1 FOR STAFF UST ONLI General Plan Designation: Zoning Designation- Use Type: Department Approved Denied SignIal Date CDD:Planning Division Building ivision Fire District: Environmental Health Department Department of Public Works MHCSD(if applicable) License approved for: a A W 0- -/1 A'1 1, 21 IZ History: D ,., I, Finalized by: Date