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WP0043699
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4200/4300 - Liquid Waste/Water Well Permits
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WP0043699
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Entry Properties
Last modified
10/5/2022 1:16:29 PM
Creation date
10/5/2022 12:59:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0043699
PE
4372
STREET_NUMBER
1009
Direction
S
STREET_NAME
AIRPORT
STREET_TYPE
WAY
City
MANTECA
Zip
95337-
APN
24131038
ENTERED_DATE
8/31/2022 12:00:00 AM
SITE_LOCATION
1009 S AIRPORT WAY
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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SITE ADDRESS: PERMIT#: <br />Plot Plan: <br />(:nnrriinmt— I nfif. ..4— <br />LU .Ynuu C. <br />I, the Owner/Applicant/ Licensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless <br />the County and its officers, 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, 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 of 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 and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited <br />by law, including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any <br />person or entity, 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'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 />obligation 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 if I fail to promptly assume 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 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 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE 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 (SIGN TUR IS REQUIRED FOR WATER EXTRACTION WELL ON PRIVATE PROPERTY): <br />SIGN: PRINT: DATE <br />LICENSED WELL l t, ' CONTRACTOR: <br />SIGN: ` <br />PRINT: � � � � DATE <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />1, hereby authorize <br />Name of LiccnxJ Authorized Representative Print Name of Authorized Agent <br />to sign this San Joaquin County Well & Boring Permit Application on my behalf. 1 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 />EHIY93-06 04'07;2022 Page 2 nr'_ Well / Pump Permit <br />
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