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SITE ADDRESS: . \UPERMIT #:
<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 out
<br />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 part,
<br />approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for 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 by
<br />law, including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any person
<br />or entity, private attorney general fees claimed by or awarded to any party against Etre County, and the County's costs incurred in preparing
<br />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 separate
<br />outside counsel to represent or defend the County, and i shall pay the reasonable attomeys' 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 JOAQUIN
<br />COUNTY ORDINANCES, TE LAWS, AND RULES AND REGULATIONS. i ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND
<br />ACTIVE WITH Tom" rALIFQRNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS
<br />SIGN:
<br />LICENSEE)
<br />SIGN:
<br />PRINT
<br />PRINT:
<br />ano DATE
<br />sm DATE
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />, hereby authorize
<br />(N... oCC-57 Lice -cd Autho,i,z Rrynsentu+3vck (Print N.—or Aoth-t dAp,-,)
<br />to sign this San Joaquin County Well & Boring Permit Application on my behalf. l 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 />EHD 43-08 WELL DESTRUCTION PERMIT
<br />11/23/21
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