|
-12/08/2021 13: 16 Canepa & Saris (FAX) P, 007/00-1
<br />/7 1 (%
<br />rrEADDREss: �� o�-�D�'-� r1�-'Airy r���r t.�t.�:.�,. lay:RMIT�:...._._.�.._�....�......_._ ._
<br />the county end Rs officers, officials, employees, agents, boards, end commissions (collectively °County') as follows:
<br />1. Indemnity:
<br />a, From and egelnst any and all claims, demands, actlons, proceedings, lawsuits, losses, damages, judgments and/or llabilihes arising out
<br />of, related to, or in connection with the application and applied for well or pump or to ahack, set aside, void, or annul, In whole or in part,
<br />approval or denial of the applied for permit by tie County, and eny environmental review documents related to the applied for permit
<br />b. For any and all costs and expenses inwrred by the County on account of any Claim, except where such Indemnification is prohibited by
<br />taw, Including but not fimited to damages, costs, expenses, attorneys fees, or expert witnew costs that maybe asserted by any person
<br />or entity, privats attorney general fees claimed by or awarded to any party against the County, and the County's costs Incurred in preparing
<br />an administrative record which are not paid by the petitioner.
<br />C. Except w to the County's sole negligence or willful misconduct.
<br />2. Defense;
<br />a. T1ia County may particlpate or direct the defense of any Claim. The Countys actions In defense of any claim shall not relieve me of any
<br />obligation to indemnify, defend, and hold harmless the County.
<br />b. In the event of a disagrooment between County and me regarding defense of any Claim, the County shall have the authority to control
<br />the Rogation 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 copnsel presents such counsel with a conflict of interest, or ti I fail to promptly assume the defense of
<br />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
<br />outside counsel to represent or defend the County, and I shall pey the reasonable ettonteys' foes and costs of such counsel.
<br />I HEREBY CERTIFY THAT I HAVE PRUPAP213 THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WiTI SAN JOAQUIN
<br />COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND
<br />ACTfVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANGE WITH ALL WORKtRS
<br />COMPENSATIQN LAWS,
<br />PROPORTY ZA:
<br />slow.�_� i .� PRINT: DATE
<br />I.IC'>'�'�'S>LA RII. PMPGONittAC'IOR: q�� ���/ss 1
<br />SIGN: l�GJ�-P�%I� PRINT•✓/7"�' !—/1" DATE I �•" i �C+f Z �•—
<br />AUTHORIZATION FOR OTHER, THAT C-57 SIGNING PERMIT APPLICATION
<br />t, , hereby authorize
<br />Q:aae ofC,l7 LiccweO Avhori;W ftgr<toetesv0) (PrSM Tlmc Ottiuiwt�d.16[at)
<br />to sign this San 7oaquin County Well & Boring Permit Application on my behalf. I understand this authorization is valid for one year and
<br />is limited to the work plea dated on ;lie front page of this application,
<br />EHD 4s -0e WELL DEB7RUGTl0N PCRMrT
<br />
|