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1; I01� i Its 111'. I, the Owner/Applicant(Licensed Well Driiler/PlxnP Contractor agrees to Indemnity, defend with counsel reasonably approved by County. 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, actions, proceedings, lawsuits, losses, damages, judgments and/or 6abifities arisir►g ou 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 part, approval or denial of the appled for permit by the County, and any environments! review documents related to the applied for permit; b. For any and all costs and expenses incurred by the County on account d any Clain, except where such kldemnrKation► is prohibited by taw. ktcludirrg but not limited to damages, ,expenses, attorneys fees, or expert witness costs that may be asserted by any person or entity, private attorney general fees claimed by or awarded to any party against the County, and the County's costs incurred in preparing general an administrative record which are not paid by the petitioner. c. Except as to the County's sole negligence or wWful misconduct. 2. Defense: in defense d an claim shall not relieve me of any a. The County may participate or � the defense d any Claim. The County's actions Y obligation to indemnify, defend, and hold harmless the County. defense of any Claim, the County sham have the authority to control b. In the event of a disagreement between County and me regarding the Wigation and make ibgelion decisions, including, but not Nmited to, the manner in which the defense is conducted.assume the defense d If County reason* determines that g conwrnon counsel presents such counsel with y thOf conflict of ie fi e, if I fad to promptly any Claim or to promptly employ counsel reasonably to the County, then County ofthe tY Counsel or employ separate outside counsel to represent or defend the County, and I shall Pay the reasonable attorneys fees and costs of Such counsel. THIIS AppUCAjnON AND THAT THE WORK BE CE SAN 1 HEREBY CERTIFYT $STHAVE PREPARIEDATE LAWS, RI RULES AND REGULATIONS• I ALSO CERTIFY LTHAT MY RIEC"RED LICENSEW18 CURRENT AND COUNTY ORDINANCE , LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE cok:T1AW"S.P PRfNT:SIGN: LIct C croe: PRINT: t" "�VAUz-OATE AA L7� SIGN: -- %wo� AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION 1, ,hereby authorize (Aid Nam of AWbrmd AV*) (Name or Jo quined MWi my ttepresemdivt) to sign this San Joaquin County Well &Boring Permit Application on my behalf. I understand this authorization is valid for one year an is limited to the work plan dated on the front page of this application. WELL DESTRUCTION PERMIT EHD 4308 t vzsm