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SITE ADDRESS: 17423 S. Enterprise Rd., Escalon <br />Plot Plan: <br />GI <br />PERMIT #: <br />I. the OwnerApplicant/Gcensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County. and hold harmless <br />the County and its oBrcers, officials, employees, agents. boards, and commissions (collectively "County') as follows: <br />1. Indemnity <br />a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, ludgmenls ardor liabilities arising out <br />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. <br />approval or denial of the applied for permit by the County. and any environmental review documents related to the applied for permit, <br />b. For any and all costs and expenses incurred by the County on account of any Claim, except where such indn_mnification is prohibited by <br />law. including but not limited to damages, costs. expenses. attorney's fees, or expert witness costs that may he asserted by any person <br />or entity, private attorney general fees claimed by or awarded to any party against the County, and the County's costs incurred in preparing <br />an administrative record which are not paid by the petitioner. <br />C. Except as to the County's 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 />obligabon 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 :f I fail to promptly assumo 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 CntlnSel or emplov separate <br />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 JOAQUIN <br />COUNTY ORDINANCES, STATE LAWS. AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND <br />ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS <br />COMPENSATION LAWS. <br />PROPERTY OAPER: '1 d <br />SIGN: �j G=- PRINT. �� ] 1�: ' - Aa-jCL _1i.S DATE _ }ZZ <br />1 N M:� iF:U N'1:L1 Dkl1.L1:WI't %tP ('u\ 1 N �1 i i ua Q y� �r Sean Roc1 <br />SIGN. Q� _ 11,.. �° 00p,, (T: riennings Bros. Drilling by DATE ll lly 21 202: <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICA HON <br />1, . hcrcbv authorize <br />,�ms.w r -;' i Kn+ud AWipvucd Ngat.;+,afn ri . nr: brim ..,• AL;:R.n::A 4 :.... _ _ <br />to sign this San Joaquin County Well K Bening 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 />EHD 43-08 WELL DESTRUCTION PERMI' <br />11/23121 <br />