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,A TE ADDRESS: PEMUTIV:r9Q <br />PI <br />GI <br />1 the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify, defend with course) 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 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 or, account of any Claim. except where such indemnification is prohibited cy <br />law including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any persof,, <br />or entity, private attorney general fees claimed oy 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 />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 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 t AM IN COMPLIANCE WITH ALL WORKERS <br />COMPENSATION LA S. <br />PROPERTY OWNER: <br />SIGN: X PRINT: r 6eor ,,�e �� Lie � DATE <br />I.I( F\SF:D N F . L► 1 F' -Pt MP C JI\ tH.\( 1C1R: 1 Ll� <br />SIGN: __✓��PRINT: i v�b-LFv -r DATE <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />_ _ _ _ , hereby authorize _ <br />1\+me ar C•3" LKvxwJ AmWiml Repnsemalve) 1PtYY �+cr oLlyfilcbnl .l yeatl —_. _ to sign this San Joaquin County Well & Boring Permit Application on my behalf. 1 understand this authorization is valid for one }'ear and <br />is limited to the work plan dated on the front page of this application. <br />END 43"08 WELL DESTRUCTION PERMI' <br />11/23121 <br />