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SITE ADDRESS: r� l� �' �i C8>�`� PERMIT #: I. the OwnertApplicantiLicensed Well Driller; Pump Contractor agrees to roemnify defend with counsel seasonably approved by County, and hold harmless the County and its officers, officials, employees, agents, boards. and commissions (collectively County') as follows. 1. Indemnity: a. From and against any and all claims, demands, acr.ons, proceedings, lawsuits, losses, damages. judgments andior Iiabilit.es arising out of, related :o. or in connection mth the applicalon and appbed for well or pump or to attacK, set aside, void. or arn,rt, in whole or in part, approval or denial o' the appl,ed for permit by the County, and any environnjewmal review documents related to the applied lot permit. b. For any and all costs and eiipenses incurred by the County on account of any CAa:m. except where such indemnification is prohibited by law, including but not fimRed to damages., cors, expenses, atlomey's fees, or expert witness casts that may be asserted by any person or enbty, private attorney general fees claimed by or awardec to any party against the County. and the County's costs incurred in prepenrg an administrative record which are not paid by the peKoner. c. Exceot as to Ute County's sole regligenre or 4ltu; misconduct Z. Defense: a. The County may participate or direct the defense of any Claim. The Co.lnty s actions ^r defense of any claim shall not relieve me of any obligation to mdemlufy.. defend, and hole nameless the t'.atlnty. b. In the event of a disagreement between Ccurty and me egaraing defense of any Claim, the County snail have the authority to control the litigation and snake litigation decisions. including, but not limited to. the manner in which the defense is conducted. It County reasonably determines that having common counsel presents such counsel with a conflict of interest, or if 1 fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably sat,sfaGory 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 attomcys 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 JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. PRorERTY OWN S16N: �� PRINT: I.it -rNrn\triI DRill1'WPI NPfn\TRa1 Il1k[ SIGN PRgHT: DATE L� DATE�- j -� 1 AUTHORIZATION FOR OTHER THA? C-51 SIGNIti(; APPLICATIOti I , . hereby authorize ----- F. ' r•'v Laa ..: {t':l.r•A]4d !�':W to sign this San Joaquin County Well & Buring Pernin Applicatlun on my behalf: I understand this authorization is valid for one your and is limited to the work plan dated on the front page of this application_ F.:rIN.NSA uvi� Aea +',c. _ _ War .Pons±. Pernnl