Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
SITE ADDRESS: { z4fly A I' G& VA m a M "l/ PERMIT #: <br />Plot Plan: <br />I, the OwnedApplicanN icensed Wei DdllerfPump 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 />Indemnity: <br />a. From and against any and all daims, demands, actions. proceedings, lawsuits. losses, damages, judgments andfor liabilities arising <br />out of. related to. or in connection with the application and applied for well or pump or to aVm*, set aside, void, or annul, in whole 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 arty and of costs and expenses incurred by the County on account of any 0aim, e=ept where such indemnification is prohibited <br />by law, including but not limited to damages. costs, expenses, attorney's fees, or expert witness costs that may be asserted by any <br />person or entity, private attorney general fees darned by or awarded to any party against the County, and the County's costs Incurred <br />in preparing an administrative retard which are not paid by the petitioner. <br />C. Except as to the Cour>ty's sole negligence or willful misconduct <br />2. 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 the County. <br />b. In the evert 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 detemrines that having common counsel presents such counsel with a conflict of interest, or if I fall to promptly assume the defense of <br />any Claim or to promptly employ counsel reasonably satisfactory to the Co", 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 />1 HEREBY CERTWY 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 />LtCFNS6D WPl I LISR/PUINP C DK17t CT0 t: <br />Slav: --�' PrtAfr: �co /?L Ma fr //N DATE <br />5, -9-2z <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />, hereby authorize <br />ii. ofC-sr ria rcaaf.--b6.t <br />Pant Name or Ao&xmW Ageal <br />to sign this San Joaquin County Well tit 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 />EHDO43A6 IWVMI Page 2 of 2 Well / Pump Parma <br />