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SITE ADDRESS: ! �`� Ywv*-.rI PC- 9 y PERMIT # UV ;i l � � I
<br />1, the Owner/Applicant/Licensed Well Driller/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 />Indemnity.
<br />a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, juagments and/or liabilities arising
<br />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
<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 incuned by the County on account of any Claim, except 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 claimed by or awarded to any party against the County, and the County's costs incurred
<br />m preparing an administrative record which are not paid by the petitioner.
<br />_. Except as to the County's sole negligence or willful misconduct.
<br />Defense:
<br />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 indemn fy, defend, and hold harmless the County.
<br />b. 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 d 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
<br />separate outside counsel to represent or defend the County, and 1 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 OWNER (SIGNATURE IS REQUIRED FOR WATER EXTRACTION WELL ON PRIVATE PROPERTY):
<br />SIGN:
<br />PRINT:
<br />LI( ENSFO NVF'LL DRII.LFI L>IP CONTRA TOR:
<br />SIGN: y/ PRINT: tNt I
<br />DATE /
<br />1 DATE % I _V7
<br />T, Q RATION FdR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />1, v11�- 6' ✓ ') hereby authorize rpS6D•1 �Y4�rn,s . ��
<br />Nunes• of C•.S I LSrnecil dmlwwsd Rryrt , Prinr N.— ur Aullvr-,i A nt
<br />to sign this San Joaquin Cuwtty Well & Borutg Permit Application on my behalf. I understand thi author- tion is valid for one year and
<br />is limited to the work plan dated on the front page of this application. o
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<br />EIID043-U0I 67QU22 i1q, 2.12 woil/ Aurq Kt—
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