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WP0043251
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4200/4300 - Liquid Waste/Water Well Permits
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WP0043251
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Entry Properties
Last modified
6/13/2022 7:57:12 AM
Creation date
6/13/2022 7:54:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0043251
PE
4373
STREET_NUMBER
0
STREET_NAME
STEWART
STREET_TYPE
RD
City
LATHROP
Zip
95330-
APN
213110040
ENTERED_DATE
4/29/2022 12:00:00 AM
SITE_LOCATION
0 STEWART RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2022
Tags
EHD - Public
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DATE <br />SITE AIDDRESS: lie Waft 124/ P4f4d0 <br /> <br />PERMIT #: <br /> <br /> <br /> <br />Plot Plan: <br /> <br />, f 1 P I .. t it IIIIIIIII 11111111111E1111111•111111111111111111111111111111 EMIII1 <br />Jil 0 1 6. ffiallillIMINIMMIIIIIMMINIME.11.11111.1.1111111111111111111111M 11E111111111EIMINNPAMITIIIIINIIIIIII41111111111.1111ALITT1111111111111 <br />LIVNINS11512111111111111111111111111 I I I <br />INI11111111111111111111111 <br />0111111111 iiiiiiiiiiiiillispirtoppliiiiii 1111111111 <br />Iiiiiiiiiiiiiiiiiiiiiiiikiiiiiiiiiiiiiiii I <br /> 1 <br /> • <br />1 ..........1.11,1111,11111 <br />GIS Coordinate: Latitude: <br /> Longitude: • 1 <br />I. the Oviner/Applicant/Licensed Well Dril er/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 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 />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 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THAT THE WORK vinu_ BE DONE IN ACCORDANCE WITH SAN JOAQUIN <br />COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED UCENSE IS CURRENT AND <br />ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE UCENSE BOARD AND THAT I AM IN COMPUANCE WITH ALL WORKERS <br />COMPENSAT1 <br />CTOR: <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> , hereby authorize <br />(Name of C-57 Licensed Authorized Representative) <br />(Print Name of Authorized Agent) <br />to <br />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 />EHD 43-08 <br />PROPERTY <br />SIGN: <br />LICENSED <br />SIGN: <br />PR t <br />11/23121
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