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Plot Plan:
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<br />PERMIT #.
<br />I, the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County
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<br />, 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 Gaims, demands, actions, proceedings, lawsuits, losses, damages, judgments andlor 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 indemnification is prohibited by
<br />law, including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be 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
<br />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 parti
<br />cipate 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 />D. 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 attomeys' 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, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND
<br />ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AIM IN COMPLIANCE WITH ALL WORKERS
<br />COMPENSATION LAWS,_
<br />PROPERTY OWNER: Q
<br />SIGN: PRINT: ' DATE
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<br />//�� -- - - - - a- - - --'- - - - ---- - ,—
<br />LICENSED WELItLI, vMP[.O
<br />��MRACTOR:
<br />SIGN: ,, PRINT; Lauren Sipich 04/06/2022
<br />t I DATE
<br />4r,
<br />RIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />—*A; hereby authorize Laurer/ Sipich
<br />Name of C-57 Licensed Authorized Repreaentutivc Print Name of Atnhorized Agent
<br />to sign this San Joaquin County Well & Boring 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 29-01 03-29-22 Site Miiigation Well/Boring Permit Application
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