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<br /> 12/08/2021 13,14Canepa c: Sons (FAX) P.003/007
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<br /> ITE AbDRRSs: C� � � �� ! PERMIT#t
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<br /> I,the Owner/ApplicanVLicensed Well DhllerlPump Contractor agrees to indemnify,defend with counsel reasonably approved by CoUnfy,and hold harmless
<br /> the County and its officers,ofliclals,employees,agent,boards,and commissions(collectively"County")as follows:
<br /> 11 Indere pity.
<br /> a. From and against any and all claims,demands,actions,procEedings,lawsuits,losses,damages,judgments and/or liabilities arising out
<br /> of,related to,or in connection with the application and applied for well or pump arta attack,set auido,void,or annul,in whole or In part,
<br /> approval or denial of the applied for permit by the County,and any environmental review documents related to the applied for permit;
<br /> b. For any and all costs and expenses Inclined by the County on account of any Claim,except where such Indemnification is prohibited by
<br /> law,including but not limited to damages,costs,expenses,attomeyrs fees,or Wed witness costs that may be asserted by any person
<br /> or entity;private ottomeygenaral fees claimed by or awarded to any party agalnstthe County,and the Couliys costs incurred in preparing
<br /> an administrative record which are not paid by the patidonar.
<br /> C. Exwpt as to the Counys sole negligence or willful misconduct,
<br /> Z. Defense:
<br /> a. The County may participate or direct the,defense of any Claim.The Counys actions In defense of any claim shall not relieve me of any
<br /> obligation to Indemnify,defend,and hold hanniess the County.
<br /> b, in the avant of a disagreement between County and me regarding defense of any Claim,the County shall have the authority to control
<br /> the Ittigation and make litigation decisions,Including,but not limited to,the manner in which the defense is conducted.
<br /> If County reasonably determines that having common counsel presents such counsel with a conflict of Interest,or ff I fail to promptly assume the defense of
<br /> any Claim or to promptly employ counsel reasonably salisfaotory to the Coun(y,then County may utilize the Office of the County Counsel or employ separate
<br /> outside counsel to represent or defend the County,and I shall pay the reasonable alt ineys'fees and costs of such counsel,
<br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL Be DONE IN ACCORDANCE WiTH SAN JOAQUIN
<br /> COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGUtAT1ONs, 1 ALSO CERTIFY THAT MY REt1 "D LICENSE IS CURRENT ANO
<br /> ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND nAT 1 AM IN COMPLIANCE WITH ALL WORKERS
<br /> COMPENSATION LAWS.
<br /> PROPERTY OyR: ((JJ/l1,,1ff��//�� ////' / \ /
<br /> SIGN: dLDA7t? 2-1
<br /> LrCeNSen ty r.LDi�/�T, JYonu CONTRA OR: •p ,� r�
<br /> $IGN'• Gd''1fi�li/ PRIN �1�/ �'"^�l DATE
<br /> A.UTHORIZATTON FOR OTHER.TRAN C-57 SIGNING PERMIT APPLICATION
<br /> Y, ,hereby authorize
<br /> M"m,oic-5Y ra,m:ea nuiaorLmropmmad.,) �w Nov orAniharmd t$wq
<br /> to sign this San Joaquin County Well&Horiug Permit Application on my behalf.I:uaderstand this authorization is valid for one year and
<br /> is limited to the work pL.n dated on tree front page o£flus application.
<br /> eun WELL DESTRUOTIONPERMIT
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