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12/03/202'1 '13:15Canppa & Sors
<br />Sri-EADDRE55:
<br />Plot Plan-,
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<br />(FAX) P.005/007'
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<br />NMI I
<br />No
<br />mom IFA 0
<br />01 MOM
<br />0
<br />0 0 WIN
<br />im MOMMEMM 0 0 M ONE
<br />MOMINNOMM mm No
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<br />M INN Molina
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<br />8 M MEMNON■a
<br />0 NUNN OEM
<br />No mom
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<br />WellUrillerl Duller/Pump defend Wj �unqel reasonably approved by Quun , and hold harmless
<br />P L�qq!Tr�fy,
<br />'Ih' "- — . -- .... . ... ...... ..
<br />and Comm) tons (collecuiveTy *i�4uiif as 1,076ws:
<br />the County and its officer officials, employees, agents, boat"Z
<br />1. Indemn
<br />a From I nd against any and all claims, demands, actions, proceedings, law-aults, losses, damages, judgments endo IlablRbes arising out
<br />of, related to, or in connection with the aipplication and applied for well or pom� or to attack, set aside, void, or annul, In whale or in pa
<br />appr'pyaf or denial of the appried for penpit by the County, and any environmGptal review documents relatud to the appri¢d for permit �y
<br />b, 56r Iny and all costs and expenses incurred by the County on account of ani, Claim, accept where such indamniffoafion is prohibited law, ildcluding but not limited to damages, costs, expenses, attorney's fees, vl expert witness cost that bray be asserted by any person
<br />or", pn'Viate uttQmQy general fees cWmed by or awarded to any party agallst the Courity, and the County's cost., Incurred in prup-ahl?q
<br />an aiJininisrtrat've record which are not p : aid by the petitioner.
<br />EXZ6 5 to the County's e negligence or wlllfv[ m[sQonducL
<br />2. Defense;11 W
<br />2. The'ounty may participate or direct the defense of any Claim. The Ccunys fictions In defense of" claim shall trot reffave me of ey
<br />obli I @tIon to indemnify, defend, and hold harmless the County,
<br />b. In th (event of a disagreement between) County and me regarding defense of any Claim, The County small have ule authority to control
<br />bl
<br />the I Ugetion and make Ilb9don decisions, Including, but not limited to, the ma6cr In which The defense Is conducted.
<br />I'Courityreasonablyde ilminez that having common counsbi presents such counsel vAlh I confl.ict orintomt off I fail to prompdyiI�Vrne the defense bl
<br />any C4alm or to promptly piploy counsel reasonably satisbelory to the County, then County may t1blize the Offlce of the County Couns 11 or employ sap
<br />outside counsel torepr e.htordefend the County, and I shall pay the reasonable attorneys' fees and costs of such counsel.
<br />1 HEREBY CERTIFY Y Iti T I HAVE PREPARED THIS APPLICATION AND THAT THE WORK *LL BE DONE! IN ACCORDANCE SAN J1 UI
<br />COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CER-nF`Y THAT MY REQUIRED LICENSd IS CURRENT ANI
<br />ACTIVE WrM THE IVCRNIA MNTRACTORS STATE LICENSE i3oArZD AND TH'P-r I AM IN COMPLIANCE wrrk ALL WoRKEps
<br />COMPZNSJA10N '-AVV
<br />PROPFE R
<br />SIGN'PRINT:
<br />DATZ
<br />SIGN: PRINT:
<br />AORIZ-kTION FOR OTHER THAN C-57 SIGNING PERMIT APPLIQUION
<br />1, T : , hereby authorize I -
<br />to sign this San Joaqufi� Co=tyWeU & Boring pex-rrlitApplication on my behalf. I Qerstandtbiz authorization is 'd for one year
<br />is limited to the v,,orj-, plan dated on the front page of this application.
<br />EHO43-08 wV-L DES-I'Two'noN PFJ
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