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SITE ADDRESS: 7761 W Undine Road, Stockton, CA 95206 PERMIT#:
<br /> Plot Plan:
<br /> GIS Coordinate:Latitude: 37.49152.33 Longitude:121'24'29.66
<br /> I,the Owner/Applicant/Lioensed Well Ddller/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
<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 Clain,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 Count'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 Clain,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 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 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 1 AM IN COMPLIANCE WITH ALL
<br /> WORKERS COMPENSATION LAWS.
<br /> PROPERTY ER:
<br /> SIGN: 46rPRINT:W. ,y O L"441)G� DATE �'
<br /> LICENSED WEL DMLLER/PUMP CONTRACTOR:
<br /> , r,� s— 1 DRobert"Tony"Maftin //PG,C-57 RM6 3/2/2022
<br /> SIGN: Rnhart A� <� � PRINT.
<br /> ATE
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> I, hereby authorize
<br /> Nona*'C-57 Lwnwd Authc&W Repro lve P=Nsme f AuJnnad Aeem
<br /> to sign this San Joaquin County Well&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 /> F1000-061012312021 Pagc 2 of 2 W c11 l pump Pcm,o
<br />
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