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WP0042933
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042933
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Entry Properties
Last modified
3/16/2022 1:27:51 PM
Creation date
3/16/2022 12:14:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042933
PE
4374
STREET_NUMBER
3263
Direction
E
STREET_NAME
CHEROKEE
STREET_TYPE
RD
City
STOCKTON
Zip
95205-
APN
13207010
ENTERED_DATE
1/25/2022 12:00:00 AM
SITE_LOCATION
3263 E CHEROKEE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2022
Tags
EHD - Public
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GIS Coordinate: Latitude: __ Longitude: <br />I, the Owner/Applicant/Licensed Well DrilierlPump 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 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 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 1 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 />- <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, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LiCENSE IS CURRENT AND <br />ACTIVE W1TH THE CALIFORNIA _CO�TRACTORS STATE LICENSE BOARD AND THAT I Ab1 IN COMPLIANCE WiTH ALL WORKERS <br />COMPENSATION LAWS. <br />PROPERTY OWNER:1/11/2022 <br />Nicholas Peters DATE <br />SIGN' PRINT' <br />LICENSED WELL DRILLER/Y,(IMPCONTRACTOR: 1 )i � <br />SIGN- /_i'"�`%,l "L --'k. T PRINT: I�Il l-�C',=f' 1 SC ,1 DATE t �l <br />AUTHORiZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />1 __ , hereby authorize <br />('vanx o1 C-57 Licensul Aullwrvcd Aepresnvnli�e) (F'nnt N-1.lulix,11icil .4grn0 <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 />EHD 43-68 WELL DESTRUCTION PERMIT <br />19123/21 <br />
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