|
12/08/2021 13:13Canepa & Sone (FAX) P.002/007
<br /> O,S'�� 3d—•�yD � 1 t u
<br /> 17,
<br /> ,DDPESS; ZeZ6 S. r oC,r -°^' f` CA PERMIT#�
<br /> A glans
<br /> . Q
<br /> .i
<br /> i
<br /> i
<br /> 1
<br /> GlS Coordirlato;Latter& r Longstude
<br /> I the n,.,tsarlAppGcsrdlLican3ed-11�tltxldlleri�'ump-Coq Srast-(4-igdamgNy,-def+esid-wish-GotlgSei-raasonaWY- #Y-� tyrand-11less-- —
<br /> the County and its often officials,employees,agents,boa ,and commissions(calleadvety'Countyj as Wows, .
<br /> x, indemmlty,
<br /> a. From and against any and s0&Ims ands,actions,proceedings,laww6,idssee,damegae,judgm"and(or OabLndeo grlstrxl= i
<br /> of,related to,cr kt connection with the pplloedon and applied forwell or pump or to attack,sat seals,void,or annul,In whok or In ped, l
<br /> approval or denial of the applied forR by the County,and any environmental review doeumegts related to the aWad for parnit; j
<br /> b. For'*my and all costs and a�gsenses in n'ed by the County on swovnt of any Claim,woevt where such trrdemnitication is prohibited by }
<br /> law,including but not�mRed to damag ,casts,expenses,attomay s tees,or mart witness costs that may.be a merted by any person
<br /> or ontlty,private attomsy general fees Calmed by or awarded to any party against the County,and Ula CounVs cost Incurred In prop drag
<br /> an sdmthWrettve record which are not 11'id by the peWortsr,
<br /> G Except as to the Countys sole n6glig4nle orlmltftul misconduct.
<br /> z, Deferzal
<br /> a, 'rhe County may participate or direct defense of any Clalm,The Countys'ac tons in defense of any claim shall not reiteve me of any
<br /> obllpa on to indemnify,defend,and holi I harmless the County,
<br /> b. In the event of d dlseovement botwee County and me regarding defense srf any Cialm,the Ccurty shell have the ovale*to oontroi
<br /> the Ii1f•®ation and make pGgadon d including,tsut not limited to,the manner in whldl thin adartsu is wnducdsd.
<br /> If County reasonably dotermtn%that having common cwn.el presents such counsel vlth a conAirt of Mtersst,or It I tali to promptly assume the defense of
<br /> any Claim or to prom ptly employ coursai rawonebly patisk to the County,then County may ulhe the Office of file County Counsel or employ eepa*1v
<br /> ou+slde counsel to reprdsent or defend the County,and I sh It pay the reasonable aftmeys'fees and costs d ovch counsel.
<br /> I HEREBY CERTIFY THAT I NAVE PREPARED TMS API I,ICATION AND THAT THE WORKWILI_HE DONE.IN ACCORDANCE WTM SAN JOAQUIN
<br /> COUNTY ORDINANCE3,STATE LAWS,AND RULES A D REGULATIONS. 1 ALSO CERTIFY THAT VY REQUIRED LICENSE IS CURRENT AND
<br /> ACTIVE WITH THE CALIFORNIA CONTRACTORS S ATI~ 110E"E BOARD AND THAT I AM ,IN COMPLIANCE WITH ALL WORICMRS
<br /> MMPENSATION LAWS,
<br /> pRopah'ry ` wu ;ty
<br /> w �w & 'j� i✓J j
<br /> PRINT! IDAT11
<br /> T.tClrtsm Coxmgrosu
<br /> SIGN' .tr.� PRINTS /<<K�. ,�. 1t1�• Gf��� DAT@� �� �
<br /> ALTT'PIORLZA,TION FOR 01 HSP.THAN C-0 SIGNING: PERMIT APPLICATION
<br /> Lhcx-by atxthatizs•
<br /> A•rw�rtes•,�m a+�.a tiff) �,,�„ot�,a�neo
<br /> to sign this San 7oaquia Couaty'WeU&Boriug 1,=it Application on my behalf T un$erstaad Wo eulhot4 di,on,is viaid for oae,yeax*td
<br /> is limited to the work plan dated on the dont page of is applioation,
<br /> I
<br /> 5H0 43-08 I WELL.DESTRUCMON PERMfr
<br /> t 1r�rtt ,
<br />
|