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SITE ADDRESS: /" 4C*C14 40C 11P_VnV. 0 TYA-4 PERMIT#; �3»
<br />Ell— 01-
<br />1, the Owner/Applicant/Licensed Well Driller/I lump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless
<br />the County and its officers, officials, employe as, agents, boards, and commissions (collectively "County") as follows:
<br />1. Indemnity:
<br />a. From and against any aid 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 :if 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 an i expenses incurred by the County on account of any Claim, except where such indemnification is prohibited
<br />by law, including but no limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any
<br />person or entry, 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'; 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, eefend, and hold harmless the County.
<br />b. In the event of a disegre,sment between County and me regarding defense of any Claim, the County shall have the authority to control
<br />the litigation and make lit gation decisions, including, but not limited to, the manner In which the defense is conducted.
<br />If County reasonably determines that having ,ommon counsel presents such counsel with a conflict of interest, or if I fail to pomptly assume the defense of
<br />any Claim or to promptly employ counsel wasonably 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, STAT E 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 PC R WATER EXTRACTION WELL ON PRIVATE PROPERTY):
<br />SIGN: PRINT: DATE
<br />LICENSED WELL DRILLS MP Cn 'TRAC C)11:
<br />SIGN: .------- PRINT:�M\C 6 CVS DATE 5 Z 3 ZZ
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />1, , hereby authorize
<br />Nume of C•57 Licensed Authorized Repnroentutiv, , Print Name ofAuthorizesl Agent
<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 />EIID04346 04:07/2022 Page2,)f2 WO ! Pump Penult!
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