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SITE ADDRESS V(' S �� <br />Plot Plan: <br />PERMIT #:A%.yo qAqtO <br />I.— •-.,....•Y � , � d,�, a lwluyees, ager --s, coaros, ar,^, commissions (collectively 'County') as follo:vs: <br />1. Indemnity: <br />a. From and against any and ali claims, demands, actions, prnceecings, lawsuits, losses, carriages. 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 anv 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, casts; 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 wilifui 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 />I <br />he 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 counscl 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 snail pay the reasonable attorneys' fees and costs of such counsel <br />1 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 AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />PROPERTY'0 y/ 1 <br />H <br />SIGN; „ PRINT:, RICK 0(3AN DATE 2< Q 1 /;Z0 7-2 <br />LICENSED WE kIi R)T ? CONTRAC 1 0k: . //! <br />SIGN: PRINTI: M� l/r,' r I/ (1i� Y� ^ C 4 J'� --- DATE V f ^ <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />t --- _ _-. ,hereby authorize - --- --__— -- <br />\amc of Cal i.icenxti Aurhwrtml ReDrsentni�x ---, Drinr Va,n: ar Auitorae.! .tF<m <br />to sign this San Joaquin County Well & Boring Permit Application on my behalf I understand this authorisation is valid for one year and <br />is limited to the work plan dated on the front page ofthis application. <br />