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SITE ADDRESS:
<br />Plot Plan:
<br />Boring locations:
<br />Boring
<br />Latitude
<br />Longitude
<br />A
<br />37.880405`
<br />-121.266302°
<br />B
<br />37.876608°
<br />-121.265885°
<br />C
<br />37.849715°
<br />-121.260645°
<br />D
<br />37.836160'
<br />-121.2591
<br />E
<br />37.836158°
<br />-121.259072°
<br />See attached pages for boring locations,
<br />GIS Coordinate: Latitude:
<br />Longitude:
<br />PERMIT #: w(C',
<br />I, the Owner/Applicant/Licensed Well Driller/Pump Conlractcr agrees to Indemnify, defend vrith counsel reasonably approved by County, and hold harmless
<br />t'ne County and Its officers, officials, employees, agents, boards, and commissions (coCeclively "County) as follovrs;
<br />Indemnity:
<br />a. From and against any and all claims, demands, actions, proceedings, lawsults, losses, damages, Judgments and/or liabilities arising
<br />out of, related to, or In connection Will the application and applied for yell or pump or to attack, set aside, void, or annul, In vdrole 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 Claim, except vrhere such Indemnification Is prohibited
<br />by law, Including but not limited to damages, costs, expenses, attorney's fees, or expert vrllness costs that may be asserted by any
<br />person or entity, private allomey 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 County's sole negligence or willful misconduct.
<br />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 (tie County.
<br />b. In the event of a disagreement behveen 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 wtrlch the defense Is conducted.
<br />If County reasonably delennlnes that having common counsel presents such counsel wflh o conflict of Interest, or If 1 fall 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 OWNE
<br />SIGN: / �- /, PRINT: �JrLJ 11� i�lG L5� !� DATE
<br />LICENSED \YF RILLER/PUA1P CONTRAC OR:
<br />SIGN: PLANT: Brian Young DATE 04.01,2022
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />1, , hereby authorize
<br />Nunaci Liunud Autkrizcd Repreumuive Print Nine orAuthoottd Agmr
<br />to sign this San Joaquin County Well & Boring Permit Application on my behalf. I understand this authorization is valid forone year and
<br />is limited to the Work plan dated on the front page of this application.
<br />EIrDOJ)-06 1041512021 Fa;e 2 of 1 Hell l Purtp Pmr+i
<br />
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