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Plot Plan: <br /> g <br />AN 421 7fi <br />vizor <br />SITE ADDRESS: <br /> <br />RoUSL i2-6( Whipop- <br /> <br />PERMIT #: <br /> <br />GIS Coordinate: Latitude: Orga f Longitude: <br />I, the Owner/Applicant/licensed Well Driller/Purnp 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: 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 />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 /> <br />2. Defense: 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 />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 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 attorneys' fees and costs of such counsel. <br />I <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 WITH THE C FORNIA CONTRACTORS STATE LJCENSE BOARD AND THAT I AM IN COMPUANCE WITH ALL WORKERS <br />COMPENSA LAWS <br /> <br />PRoPERre PRINT: ipt 111 DATE °4 <br />SIGN: <br />LICENSE <br />SIGN: <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> , hereby authorize <br />(Nanw of C-57 Licensed Antlicsized Represanudive) <br />(Punt No of Authonzed Agee° <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 />WELL DESTRUCTION PERMIT <br />END 43-08 <br />CTOR: cGo-tt N0155ti11ci DATE 0211/11/ <br />11/23/21