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SI ."E ADDRESS: PERMIT #: <br />I, the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and told harmless <br />ft County and its officers, officials, employees, agents, boards, and commissions (collectively 'County) as follows: <br />Inderr"ty. <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 Countys 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 misconducL <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 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 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 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 COMPENSA71 <br />PROPERTY OWNER: <br />7C- <br />\ ` 1 a Q <br />S+'CY' i1_ PRINT' 1 DATE <br />LICE.\SED W �.ER/Pum? Co\TRACTOR (� L <br />SKIN: PRINT: _ 1 ,— CY r VIE UJ � e. cl--� DATE <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />1, , hereby authorize <br />kuoe nfGJ7 txnuea Amhorved aepro�nr,icvs <br />to sign this San Joaquin County Well & Boring Permit Application on my <br />is limited to the work plan dated on the front page of this application. <br />Prim Name of AwtonuJ Agan <br />behalf l understand this authorization is valid for one year and <br />EIIMI-06IN214021 PW2cr2 <br />