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SITE ADDRESS; 1\30
<br />PERMIT
<br />I, the Owner/Applicant/Llcensed Well Driller/Pump Contractor agrees to Indemnify, defend with counsel reasonably approved by County, and hold hanmiess
<br />the County and its officers, officials, employees, agents, boards, and commissions (collectively "County) as follows:
<br />Indemnity:
<br />i. 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 (or 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 />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 shalt pay the reasonable attorneys' fees and Costs of such counsel,
<br />I HEREBY CERTIFY THAT 1 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 />PROPERTY OWNER: _�!j�� c�y�
<br />SIGN: _ /J� ! G� PRINT: JJ �y��-�, h L `3 DATE I 2 Z
<br />LrccNSED WELL DRILL F�IPUnIP CONTRACTOR:
<br />y PRINT; %1L�p,r DATE
<br />SIGN: I i Y' fiZ
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />hereby authorize _ __
<br />Meme Of C•$7 Lkeased AutholM KWewlative
<br />Prix 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 />ENDP6l-05 IM5021 Page 2 ore Well / Pump Pe`vW
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<br />I, the Owner/Applicant/Llcensed Well Driller/Pump Contractor agrees to Indemnify, defend with counsel reasonably approved by County, and hold hanmiess
<br />the County and its officers, officials, employees, agents, boards, and commissions (collectively "County) as follows:
<br />Indemnity:
<br />i. 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 (or 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 />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 shalt pay the reasonable attorneys' fees and Costs of such counsel,
<br />I HEREBY CERTIFY THAT 1 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 />PROPERTY OWNER: _�!j�� c�y�
<br />SIGN: _ /J� ! G� PRINT: JJ �y��-�, h L `3 DATE I 2 Z
<br />LrccNSED WELL DRILL F�IPUnIP CONTRACTOR:
<br />y PRINT; %1L�p,r DATE
<br />SIGN: I i Y' fiZ
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />hereby authorize _ __
<br />Meme Of C•$7 Lkeased AutholM KWewlative
<br />Prix 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 />ENDP6l-05 IM5021 Page 2 ore Well / Pump Pe`vW
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