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WP0042927
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042927
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Last modified
2/7/2022 8:15:07 AM
Creation date
2/7/2022 8:07:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042927
PE
4372
STREET_NUMBER
2955
STREET_NAME
JULIET
STREET_TYPE
RD
City
STOCKTON
Zip
95205-
APN
17304007
ENTERED_DATE
1/21/2022 12:00:00 AM
SITE_LOCATION
2955 JULIET RD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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r <br />SITE ADDRESS: <br />t�Oil J JcF.- <br />K <br />PERMIT <br />I, the Owner/Applicant/Licensed Well DrilledPump 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 A[Il). REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFO IA -CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. ' <br />PROPERTYOWNER. _ <br />SIGN: L <br />PRIHT:_ %1.... -G` 't t: DATE C2 Z L <br />LICEKSCD\'!ELL LLER/PUNP jCOYfRA�OR: <br />SIGN: / PRINT:-Qaw HPyDATE 01 �q lha? <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />l , hereby authorize <br />N1—o(G57 Lrrnstd Amhory d Reprcs.m+ti`c Priv N+ne or Amhx'vn7 Ag.nt <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 />EHD671(ri 102s :021 P+6c 2 .1`2 N OI r Pomo <br />
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