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4200/4300 - Liquid Waste/Water Well Permits
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WP0043592
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Last modified
9/14/2022 4:57:37 PM
Creation date
9/14/2022 4:54:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0043592
PE
4382
STREET_NUMBER
8241
Direction
N
STREET_NAME
TULLY
STREET_TYPE
RD
City
LINDEN
Zip
95236-
APN
09108016
ENTERED_DATE
8/9/2022 12:00:00 AM
SITE_LOCATION
8241 N TULLY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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SITEADDRESS:8241 N Tully Rd Linden,CA 95236 <br />PERMIT #: <br />■■■1�J■I�■■■■■■■■■ NOON■■ ®NOON <br />■NONE■■■■■■■■■■ ■■■■■■gym <br />■C s ��i■Ei�'_+■■■■■■■■■ M■MW■ N■■® <br />NOON■N N■NN■■■■NN NNIMMUNNOM - <br />■■■■■■■■■■■ ■■■■■■■■■O■■■■■�I■ NOON■■ <br />■ ■■■■■■N■�E■■®F.l�■■■■■■■■■■ <br />■■■® ■■ ■■■■■■■■lei■■■■■■W■■W■■ <br />■ ■■■■■NO■■moi■■■■■�! <br />■ ■■■■■NN■O■■■e;N■■■■4■■■■■■■N■■ <br />■■N■■■■■■■OMEN ■■■■■■■■■S O»■■NN■■■■■ <br />■■■■■m■■■■■■■■■■■■■■■■■N■■■■ ■■■■■■m■ <br />MEN ■■■■O■■■■■N■O■N■O■■■■■■■■■ ■ON■■N■■ <br />■■■■n■■m■■m■ OMENE■■ ME■NON■■■ <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 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 incurred 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 />in preparing an administrative record which are not paid by the petitioner. <br />c. Except as to the County'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 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 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 emp!oy <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 1 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 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />PROPERTY OWNER: <br />SIGN: <br />PRINT: <br />LIC D LLD LE U.NIP CONTRACTOR: e�� <br />SIGN: _ PRINT: 1 1 �(/I � ✓ <br />DATE <br />DATEZ 7i Zi <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />I, hereby authorize <br />Name of C-57 Licensed Authorized Representative Print Name of Authorized A, --cm <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 />EHD033.06 10.'2512021 Pagc 2 of 2 "Yell r Pump Permit <br />
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