|
SITE ADDRESS: SDI' Ing, 2:>1`-,Ve_, l l�i a✓1, f 4 PERMIT #:
<br />Plot Plan:
<br />■>•�"% 0
<br />r �
<br />ari'r�
<br />I—L_L I I I I I1 _ c� _ `_ ='911 *a"" .e."•':.",. - 1 1 1 I 1 1 1 1
<br />GIS Coordinate: Latitude: 3 7, YS7 S __ Longitude: 1'.kq k r
<br />I, 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 />1 Indemnity:
<br />a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, judgments and/or iiabiiities 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 incurred by the County on account of any Claim, except where such ndemnificalinn 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 />in preparing an administrative record which are not paid by the petitioner.
<br />c. Except as to the County's sole negligence or willful m!sconduc!.
<br />2. Defense:
<br />a. The County may participate or direct the defense of any Claim. The County's actions it defense of any claim shall not relieve me of any
<br />obligation to indemnify, 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 if I 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 COUNTYRDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS
<br />CURRENT AND AC VE ITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL
<br />WORKERS COMPENTl lJ1WS.
<br />PROPERTY OWNER (SIGN
<br />TL
<br />REQUIRED FOR WATER EXTRACTION WELL ON PRIVATE PROPERTY):
<br />��
<br />SIGN: _ PRINT: ::to4-f�, ✓— I� DATE (0wt�:
<br />—
<br />PRINT! Robert D. Slagle DATE 8/16/2022
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />hereby authorize
<br />Name n(C-5" Lice—d A.thorazd Rer-scrtallvc Pnnt Name of Aah—d Apar
<br />to sign this San Joaquin County Well & 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 />FML)04;-0 04/0712027 '�;, 2 d2 Well' Pomp Pc =n
<br />
|