WP0042961 - Laserfiche WebLink

Home Browse Search

GI. the SITE ADDRESS; PERMIT#: Lo 06 0 a-) (I1() Indemnity - wvnty i as tonews: - e. From and against any and all claims, demands , actions, proceedings, tawsurts, losses. damages. juogments andior Ilabiliiles arising o�; n. related to. or in connection with the application and applied for well or Pump or to s. da ,see aside, void, or annul, in whole or in pan, approval or denial of the appfled to( permit by the County, and any environmental review documents related to the applied for D. For any and all costs and expenses incurred ty the County or account of any Ciairn except where such indemnification is Prohibited by ah. including but not limited to damages. casts. expenses attorney's fees, or a Permit; On 80enty, private attorney general fees claimed by or awarded to an expert witness costs that may be asserted b an an administrative record which are rent paid b the Y Darty against the County, Y Y person Y e petit over b. end the County's costs incurred in preparing Except as to the County's sole negligence or willful misconduct. Defense: a. The County may Participate or d;rect the defense of arra Claim. The County's actions in defense of any Clam shalt not relieve me of any obligation to Indemni`y. defend, and hold harmless the County. b In the event of a disagreement between County and meregarding the hligation and make litigation decisions. including, but nottGmited to the manner ifense of any n�which t tlhe`defense hs (conducted authority to control If County reasonably determines that having common counsel presents such Counsel with a conflict of interest, or if I fail to rom U any Claim or to promptly empioy counsel reasonably satisfactory to the County. then County may utilize the Ofr-ce of the County Counsel or employ separate outside counsel to r P p y assume the defense or aPresent or defend the County, and I shall Pay the reasonable attortRys' fees and costs of such counsel. I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAW PROP R OWNER: SIGN: Z 1S /7w�is�itOt T/28'ZZ i.l(f VfW .p s!,rl r '{ qtr CONruPRINT: DA \ u,�eiu: (, �l SIGN: _—/moi—�Ju-D�ry,et7` PRINT: DATE AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION i..-- �a�r, rc•srt:o.4,�e 1,,a, — _ . hereby authorize _ to sign this San Joaquin County Well & Boring Permit Application on my behalf: I understand this authorization is valid for one year and r.'aa \artlr C�f WY%K)1iR[i) .°L�yN S is limited to the work- plan dated on the front page of this application. E4D 43.os 1112" 1 WELL DESTRUCTION PERMrr