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SiTE ADDRESS: PERMIT #: <br />Plot Plan: <br />I, the Owner/Appllcant/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 far 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 Pie 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 foes, o, expert witness costs that may be asserted by any person <br />or entity, private attomey general fees claimed Dy or awarded to any party against the County. and the County's costs incurred ,n preparing <br />an administrative record which are not paid by the petitioner. <br />C Except as to the County's sWe negligence or willful misconduct. <br />2. Defense. I <br />i <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 fait 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 NTH 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 1 AM IN COMPLIANCE WiTH ALL WORKERS <br />COMPENSATION LA S. <br />PROPERTY <br />SIGN: PRINT: H. Curtis Tubbs DATE 2�1 0�2�22 <br />I.I("E.Nsrtl '[.. IL PU.NP CO\7RACTQR: <br />SIGN: n <br />PRINT: R 6- 1 U &I C, L, V DATE I- Q t a�— <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />1, hereby authorize <br />{�atx nr C•37 Lk[IbN Aatnrised RR+rexrtatnel IPruu Nam a(nutherwml AIM) <br />to sign this San Joaquin County Well & Boring Permit Application on my behall. 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 />EHO 43-08 WELL DESTRUCTION PERMIT <br />11/23/21 <br />