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WEADDRES6: 5" � 6��1L �� /� & , �� PERMIT #: �N Latitude: the Owner/AppticantlLicensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless he County aril its officers, officials, employees, agents. boards, and commissions (collectively "County') as follixeis: 1. Indemnity_ a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, judgments and/or liabilities arising 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 part, approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for permit: b. For any and alt costs and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited by lata, inctuding but nct Lmited to damages, costs, expenses, attorney's fees, o: expert witriess 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 CouriWs costs irmurred in preparing an administrative record which are not paid by the petitioner. G Except as to the County's sole negligence or willful misconduct. 2. Defen-.l•: a. isle 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 obligation to indemnify, defend, and hold harmless the County. b. In the event of a disagreement between County and me regarding defense of any Claim, the Courcy shall have the authority to control the litigation and make litigation decisions, including, but riot limited to, the manner in which the defense is conducted. 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 any Claim or to promptly employ counsel reasonably satisfactory 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 attomeys' fees and costs of such counsel. I HEREBY CERTWY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCOtMANCE VAT" SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT ABY RE(21111RED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. PROPERTY OtaNER: SIGN: PwNr.— --- DATE 11,14,I. -NSE CotiIL*.croR. 7-� ,gam// �-q� l y� SIGN: PRINT: A/ &VIE 1V1 / -� 6/v DATE AUTHORI7ATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION I_ tcreby authori/e Pm37�ofAaffivrz�lA�- to sign this San Joaquin County Well & Boring Permit Application on Imy behalf. I un leistand this authorization is valid for one, year and is limited to the «-ork plan dated on the front page of this application. =11133!3-9610.25'2021 Page. 2 of 2 :'.';' 1 i'. _ .