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SITE ADDRESS*. A L hon F A Ed/J, (A PERMIT It:
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<br /> GIS Coordinate:Lafilude: Longitude:
<br /> 1,the Owner/Applicanikeensed 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 /> From and against any and all claims, demands,actions,praceadings.lawsuits, losses, damages,judgments and/or liabilities arising
<br /> a. attack.sot aside,void,or annul,in whole or in
<br /> out of.related to,or it,L;onnuction with the application and applied for well of Pump Of to
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<br /> part.approval or d'nill 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 an account of any Claim,except where such Indemnification Is prohibited
<br /> by law, Including but not Ilmitod to damages,costs,expenses, attorneys fees,or expert witness
<br /> costs 111,11 may be asserted by any
<br /> person or entity,private altorrmy general acre
<br /> by or awarded to any party against the cos and the County s costs Incurred
<br /> in ptepaiintj a,,aurninisiralive record which are not paid by the petitioner.
<br /> c. Except as to the County's sole negligence or willful misconduct.
<br /> Z. Durunsu:
<br /> G. The County may participate or direct the defense at any Claim.The County's a(,fiOns In defense of any claim shall not relieve me of any
<br /> obligation to indemnify,defend,and hold harmless 010 County
<br /> la, in the event of a disagreement between County and mu regarding defense of any Claim,the County shall have the authority to control
<br /> the litigation and make litigation decisions,Including,but nolullmited to,the manner in which the defense is conducted. knse of
<br /> 11 County reasonably determines that having common Counsel presents such CO nsol with a conflict of Interest,Of if I fall to promptly assumeue the&
<br /> any Claim or to promptly employ counslata
<br /> l reasonably satisfactory to the County, Ilion County may utilize the Office of the County Counsel or employ
<br /> separate outside counsel to represent or dofond the County,and I shall pay Ina 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 Ahd,Ac rIVE WITH CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br /> WORKER PENSATION S.
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<br /> PROPERTY 0 ER: PRINT.. C VLe15 DATE
<br /> SIGN:
<br /> L:ck. n 'N C ACrO C
<br /> PRINT: DATE
<br /> 5 ON: PRINT:
<br /> 5��jffUTI 10 1Z ION FOR OTHFR THAN C-57 �GNIN� PERMITNPPLICAT[ON
<br /> hereby authorize
<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 Eurit page of this application
<br /> 1:110011 06 10121/2021 P'll,2.1`2 WO pwq P—w
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