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12x'08!2021 13;16Canepa & Sone (FAX) P.006/007
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<br />I the Ctivr ar/App)Icxgt(UCetad Sh(aflDdpgttPuwpAoPtwat�agreas-lo IPdemgtFy� do(6�w ttt Qoutg9Frea9oRibly a old ham+
<br />the County and its oMcars, ofliciab, empityees, agent:, boards, and comm'IsNons as'failows:
<br />1. Inddrtnity:
<br />8 • From and against any and WI daims, demands, actions, ptoceemmgs, lawsuits, losses, damagos, Judgments an(vor Ilablu tt s, arising out
<br />of, related to, er In connWon with t)w applkation and applied for well or pump or to attack, set aside, void, or annul, In whole or in part,
<br />epproval or derdal of the applied for permit by the Oounly, and any environmental review dowmtufs rdatad to the aPPr�ed for permit
<br />b, 6? any and ail vests and menses inourmd by the County on account of any. Claim, except where ouch hidemnlfk Is prohibited by
<br />law, Including but not Ilmlted to damages, costs, e"nues, attorney's teas, or s)W Witness costs that may be asserted by any person
<br />or entity, private attorney general tee: claimed by or awarded to any party agaldst the CVJnV, and the County's costs incurred In proparing
<br />an adm'm}strative record which are not Od by the pa8tloner.
<br />e, Ekgept as to the County's axle reg ig!nca or willful rnisconduok
<br />a, The County may partldpate or dimer the defense of any Ol;im, the Courtty's actions In defense of any claim;hal not Wove Me of eq
<br />obligation to Indemnify, defend, and hold harmless the County,
<br />b, In the event of a d'gsgreament between County and me regarding defense of any Calm, the County snail hey* the authority to control
<br />the Ihlgation and maktr 1169adort deoblons. Including, but not limited to, the manner In which the d0onse is conducted,
<br />ff County reasonably detarmInes that having common oovmel presents such Counsel with a Conflict of hrterest, or?F I tail to promptly assume the defense of
<br />any Claim or to promptly employ counsel reasonably safl:facfiory to the County, then County may v ze the Office of the County Counsel or employ separate
<br />outside eouneei to'reprebent or defend the Co". and I shell pay the reasonable attomays' f**s and oos{s of ouch counsel.
<br />I HERXBY CE"FY THAT 1 HARE PREPARED TM APPLICATION AND THAM THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN
<br />COUNTY ORDINANC15:3, STATE CAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REOUMD' LICENSE 19 CURRENT AND
<br />ACTrvE WITH ` He CALIFORNIA CONTRACTDRS STATE UCENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS
<br />COMPENSATION LAWS, n
<br />s Nnexrr t7»e t / x -`Y FI I. Pawn. �G> U �i � ✓ DA•rr
<br />LIt7tz� ) `�or*�r Cortlwticron; /�� ��
<br />DATE i 1Z � i 0, z Z---
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<br />A'UTHORI7ATl;ON FOR OTHER THAN C-57 SIGNXNG PBRMT APPLICATION
<br />oi.me ot" ues -, hereby Authorize _
<br />to sign this San Joaquia County Well &wBoring Permit Appko ion on my behalf I wade (szd this attthoriz4on is valid for one year and
<br />Is limited to the work plan darod oa 6o front page of this appliostiom
<br />CND 49.08 WELL OF.S MUCMON PERMrr
<br />tt123/21
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