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SITE ADDRESS: PERMIT #: V" "� t, �f, L% I, the owner/ApplicanVLicensed Well DrilledPump Contractor agrees to moemnoy, vu-- ..- .--__. -- the County and its officers, officials, employees, agents, boards, and commissions (collectively 'County") as follows: 1. Indemnity: lawsuits, losses, damages, judgments and/or liabilities arising out a. From and against any and all claims, demands, actions, proceedings, of, related to, or in connection with the application and applied for well or pump or to attack. set aside, void, or annul, in whale 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 all lots and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited by law, including but not limited to damages, costs, expanses, attomeyr s 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 an administrative record which are not paid by the petitioner.. C. Except as to the County's sole negligence or willful misconduct. 2. Defense: a The County may participate or direct the defense of any Claim. The County s actions In defense of any cairn shall not relieve me of any obligation to Indemnify, defend, and hold harmless the County to control b. In the event of a disagreement between County and me regarding defense of any Claim, the County shall have the authority the litigation and make ktigation decisions, including, but not limited to, the manner in which the defense is conducted. If Couto promptly assume the defense of nty reasonably determines that having common counsel presents such counsel with a conflict interest. IuW09 the Office of the County SI or employ separate any Claim or to promptly employ counsel reasonably satisfactory to the County, then Courtly y outside counsel to represent or defend the County, and I shall pay the reasonable attorneys fees and costs of such counsel. E IN ACCORDANCE WITH SAN I HEREBY CERTIFY TKAT 37ATE 1J►W$ AND RULES AND REGULATIONS' IT THE WORK ALSO SO REQUWED LICENSE 15 URRENT AND E COUNTY STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS ACTYyE WrrH PEC.AUFORNIA CONTRACTORS rnuPFUSA LAWS. /— SIGN: _ LIC£NSED SIGN: _ PRINT: Pitt r: jg�� -DATE so—tPOLt— DAYS O C- AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION hereby authorize I, tNW N � or nurmraaa wSeall p+San J-saquinoa aunty Application on m behalf. I understand this authorization is valid for one year and to sign this San Joaquin County Well &Boring Permit App � Y is limited to the work plan dated on the front page of this application. WELL DESTRUCTION PERMIT EHD 43-08 t112Y21