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DocuSign Enyelope ID:9195FF3F-O1B2-4CB9-ASCD-B9867BBF5748
<br /> SITE ADDRESS: Corral Hollow Rd.,Tracy PERMIT#:
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<br /> GIs CoordinaLongitude:
<br /> (,the Ormer/Applicant/Licensed Well Diifler/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 Yrith the application and applied for well or pump or to attack,set aside,void,or annul,in whole or in part,
<br /> approval or deniaf 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 the 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 sale negligence or willful misconduct.
<br /> 2. Defense.
<br /> a. The County may participate or direct the defense of any Claim.The Countys 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 O�tice of the County Counsel or employ separate
<br /> 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 f HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN
<br /> COUNTY ORDINANCES, STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND
<br /> ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS
<br /> COMPENSATION LAVIS.
<br /> PROPERTY OWNER:
<br /> SIGN.'—, �Stu� PRINT Kelley Stough DATE eh , q 2-0 Z-Z
<br /> Lir'r.NsFm\4'rm-Dmi.t.r:R/Pump CO\'TR,IC oR:
<br /> SIGN. 11 Q�f'r PRINT: Hennings Bros. Drilling by Sean 13M4dy FLV,, 0i Zk)zZ
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> hereby authorize
<br /> (NE.W-57 Liecn cd.lvOwrvnl(ltpcncmativei (Print NnrR ui Autlmrird Ag yrti
<br /> to sign this San Joaquin County lVeli& Boring Permit Application on my behalf. 1 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,13-08 WELL DESTRUCTION PERMIT
<br /> 11123/21
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