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e SITE ADDRESS: 7101 Liberty Road Gal,. CA 95632 Plot Man Vic - 1 l V119'. GIS Coordinate Latitude Longitude 12123 %On% r 1, the 0,~ApplicaroiLicensed Well Dniler'Pump Contractor agrees to (ndemnify. defend with Counsel reasonab) approved Ct C�%vtty an^ hoic �',W -, ess the County and its officers offioals, employees, agents boards, and commissions (collactive? y 'Courty') as follows 1. lndemrury. a. From and against any and all claims demands actions. proceedings lawsuits lasses• damages. ucgrlents and or 6abiisies; a^-- out of, related to, or In corinact'on with the application and appiaed for well or pump or to atlaok, set aside void or annul, in whole or in part. approval or dermal of the applied for permit by the County, and any environmental rev,ew documents reiated to the app ed hx permit b For any and all costs and expenses Incurred by the Courty on account of any Claim, except where sucn ndemntlficaGon is proftb teC by law. Including but not limited to damages costsr expenses, allomey s fees or expert witness casts that may be asserted by Ary person or entity private atiorrey general fees claimed by or awarded to any party against the County and the County s casts irvo,"er;i in preparing an administrative record which are not paid by the petinoner. c Except as to the County s sole negligence or wilful misconduct 2. Defense a The County may participate or direct the defense of any Claim The County's actions in defense of any claim shall rot relieve me 0 am 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 County shall have ft a0vrity W cmtrc+r the litigation and make litigation decisions, including, but not 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 rnteresL or M 1 fall to promptty 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 kv orrpk?y separate outside counsel to represent or defend the County, and I shall pay the reasonable attomeys' fees and costs of such counsel I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN i JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. &X'T PROPERTY OWNER: If,,) SIGN: PRINT:_ DATE ��.' •� �_ .I(:r Min ,SIPCONI-R&C7oR: PRINT: David Hogan DATI 9!13/22 Si6N: f�,r...) AUTHORIZATION FOR OTHER TI IAN C-57 SIGNING PERMIT' APPI]CATION -- , hereby authorize _ h�mc cif'-17Laxnsc.l A�ific•rcd krpr�mlrtrr� Ana Natwui to sign this San Joaquin County Well & Boring Permit Application on my behalf. I understand this duthurtniptm is sated Jur one year and is limited to the work plan dated on the front page of this !application GltixM}Os t6•:S'pUp, P4V-'"I: wria abnpI',,—