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SITE ADDRESS: 0-.46. A10.7 Pr S-1-0CA4,0 1/i y CA 1?5,7,06 PERMIT #:
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<br />GIS Coordinate: Latitude: 37. ?if) e I Longitude —j pi..oni
<br />I, the Owner/Applicant/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 />
<br />1. Indemnity:
<br />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 />For any 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, 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 wh:ch are not paid by the petitioner.
<br />C. Except as to the County's sole negligence or willful misconduct.
<br />
<br />2. Defense:
<br />3. 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 indemn.fy, 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 mariner 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 attorneys' 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 I AM IN COMPLIANCE WITH ALL
<br />WORKERS COMPENSATION LAWS.
<br />PROPERTY OWNER: Jason P. Cashman
<br />SIGN: 20).3.1.11$11126 CniT PRINT: Jason Cashman DATE 2/24/2022
<br />LicENsen NN IL DRILLER/PUMP CrilACTOR:
<br />SIGN: PRINT:
<br />
<br />7 DATE _2/ 7g/ 202z.
<br />
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> , hereby authorize
<br />Nvne C•57 L.t4nsal Authonte-J Re-pf etentate NIITK or Authoracd +111 era
<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 />F110043.06 10)25.2021
<br />PJVC 1 Veil Purrp Paril
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