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01 01 SITE ADDRE88: © �n I ( PERMIT #: - -.." 4 ■von unueururrlp Contrad cfor agrees to indemnify, efend with counsel reasonably approved by County, and hold harmless the County and its oft7cers, offiaats, employees, agents, boards, and commissions (collectively ,county") as follows 1. Indemnity: a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, judgments andlor liabilities arising 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 Part, approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for permit; b- For any and ail costs and expenses incurred by the County on account of any Ciaim, except where such indemnification is prohibited by law, including but not limited to damneral ges,Ws costs, expenses, attorney's fees, or expert witness costs that may be asserted by any Person ri entity, private attorney general fe2s claimed by or awarded to any party against the County, and the County's costs incurred in preparing an administrative record which are not paid by the petitioner. c. Except as to the Gounty's 6016 negligence or willful misconduct. Defense: 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 obligation to indemnify, defend, and hold harmless the County. b. In the event of a disagreement between Gounty and me regarding defense of any Claim, the County shall have the authority to control the litigation and make litigation decisions, Including, but not limited to, the manner in which the defense is conducted. 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 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 outside counsel to represent or defend the County, and I shall pay the reasonable attomeys' 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 JOApUIN COUNTY ORDINANCES. STATIP taws, AND IauL-ma Arun ww=uuaTV,40. I A9.00 verr�Ttr=1 THAT MY REQUIRED LICENSE 1S CUIQRfiNT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I ANI IN COMPLIANCE WITH ALL WORKERS C ENSATI N LAWS. PROPERTY _ SIGN:` y/ p I 1 Qf`� LICLN3 PRINT: S (r'S�I {K f DATE L -� LL L DRM NTRACroa: SIGN' ° 7 I , PRINT: ? : V H14 DATE J7 'y- 0c0 Z -- AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION f. Name orC-37IJcenseA AUIhp�� Atpresentntive s hereby audiorize to sign this San Joaquin County Well & Boring permit Application on my behalf. i understandthithis authorfzation is valid for one year and is limited to the work pian dated on the fl'oni page of this appBeation. E M043 -o6 IGW/2021 F.0.2 oF2 Well / Pulp Per nfl