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WP0042812
EnvironmentalHealth
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ARTHUR
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042812
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Entry Properties
Last modified
10/4/2022 12:56:07 PM
Creation date
1/12/2022 9:33:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042812
PE
4370
STREET_NUMBER
23762
Direction
E
STREET_NAME
ARTHUR
STREET_TYPE
RD
City
ESCALON
Zip
95320-
APN
229030110
ENTERED_DATE
12/8/2021 12:00:00 AM
SITE_LOCATION
23762 E ARTHUR RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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SITE ADDRESS: 3 -7& Z U— E4t#440Nlc eA' PERMIT#E: <br /> Plot Plan: <br /> GIS Coordinate:Latitude: — Longitude: /- o/ — <br /> I,the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify,defend with counsel reasonably approved by County,and hold harmless <br /> the County and its officers,officials,employees,agents,boards,and commissions(collectively"County')as follows: <br /> 1. Indemnity: <br /> a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages,judgments and/or liabilities arising <br /> out of,related to,or in connection with the application and applied for well or pump or to attack,set aside,void,or annul,in whole or in <br /> part, approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for <br /> permit; <br /> b. For any and all costs and expenses incurred by the County on account of any Claim,except where such indemnification Is prohibited <br /> by law, including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any <br /> person or entity,private attorney general fees claimed by or awarded to any party against the County,and the County's costs incurred <br /> in preparing an administrative record which are not paid by the petitioner. <br /> c. Except as to the County's sole negligence or willful misconduct. <br /> 2. Defense: <br /> a. The County may participate or direct the defense of any Claim.The County's 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 disagreement between County and me regarding defense of any Claim,the County shall have the authority to control <br /> the litigation 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 if 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 <br /> separate outside counsel to represent or defend the County,and I shall pay the reasonable attorneys'fees and costs of such counsel. <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> PROPERWN R: I2 r <br /> l� ` <br /> SIGN: � 1 PRINT: � �)LAlIr�1L'f_ _� i�'�/�' DATE (✓1h �-' <br /> LICENSED L-DRILL CONTRACTOR: <br /> SIGN: PRINT: / ey & <br /> r DATE /Z -, Z <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> I, hereby authorize <br /> Name ofC-57 Licensed Autborized Representative Print Name of Authorized Agent <br /> to sign this San Joaquin County Well&Boring Permit Application on my behalf.I understand this authorization is valid for one year and <br /> is limited to the work plan dated on the front page of this application. <br /> EI-m043-06 10/25/2021 Page 2 of 2 well/Pump Permit <br />
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