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SITE ADDRESS; J �'' (� PERMIT N:' lr0 J lI
<br />I• the 04nerfApplicantA1censed well DrllrerfPump Contractor agrees to indemnify, defend witn course) reasonably approved by County, and hold harmless
<br />the County and Its officers, officials, emoloyees, agents, boards, and commissions (collectively'Countyr) as follows:
<br />Indemnity:
<br />a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, judgmerls andlor liabilities arising
<br />out of, related to, or in connection with the application and applies for well or pump or to attack, set aside, void, or annul, in wh6e or in
<br />part, approval or dental of the applied for permit by the County, and any environmental rev,ew 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 Claim, except where such indemnlllcallon 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, privale attorney general fees claimed by or awarded to any party against pie County, and the County's owls incurred
<br />In preparing an administrative record vtiich are not paid by the petitioner.
<br />c. Except as to the County's sole negligence or vdliful rrdsoonduct,
<br />Defense:
<br />a. The County may participate or direct the Catena cl 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 dacsions, Including, but not 1,mlted 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 re;resem or defend the County, and I shall pay the reasonable attomeysr foes 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS
<br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I APA IN COMPLIANCE WITH ALL
<br />WORKERS COMPENSATION LAWS.
<br />PROPERTY C
<br />SIGN: _
<br />Llct:xsv.o w
<br />SIGN: _-4
<br />CONTRACTGR:
<br />PRINrlf:rE.�i tNl tJ+r�•,i'o,J DATE
<br />PRINT. Jake Wilson DATE 311112022
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING P 11TH N
<br />PLIC T
<br />I, l (It11_ )a ( t 1 �0 herehy authorize ✓'`�
<br />arC-77Licei AatToriullle,�r, etive Mmtreefeo A Ay
<br />to sign this San Joaquin County Wcll & Boring Permit Application on my behalf. I understand this authorization is valid or one _near and
<br />is limited to the work plan dated on the front page of this application.
<br />EION3.116 IWL%W:1 Page a or:
<br />W,I '.,.'4 rc w
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