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SITE ADDRESS. 3295 N Alpine Rd Sto .kto 195? t 5 - PERMIT #- Plot Plan: I, the OwnedApplicanULicensed Well Driller/Rump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless the County and its officers, officials, employees, agents, boards, and commissions (colleetively'County"j as follows: 1. Indemnity. a. From and against any and all claims, demands, acCons, proceedings, lawsuits. losses, danages, judgments and/or IiabiGbes arising 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 to part, approval or denial of the applied for pennd by the County, and any environmental review documents related to the applied fo- pennd. b. For any and all costs and expenses incurred by tho County on account of any Claim, except where such indemnification is prohibited by law, including out not limited to damages, costs expenses, attorney'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 part' against the County, and the County's costs incurred in preparing an administrative tecord 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 Clairn. The County's actions in defense of any claim shall not relieve me of any 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 the authority to control the :itigetion and make litigation decisions, including, but not imited to, the manner in which the defense is conducted If County reasonably determines that having common counsel presents such ccunsel with a conflict of interest, or if I fail to promptly assume the defense cf any Claim or to promotly employ counsel reasonably satisfactory to the County, then County may utilize the Office of the County Counsel or employ separate outsice counsel to represent or defend the County, and I shall pay the reasonab;e attorneys' fees and coats of such counsel. I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACME WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. PROPERTY ONMER: Jj-- �/ '�1�% PRIVE Wuwa WCle1.L1.L DATE • ` V% 2 CIOR: ' PR*n: Austin Loock CEO AUT14ORIZATION FOR OTHER TMA N C-57 SIGNING PERMIT APPLICATION 1• .._ hereby authorize Nit=vfC,57 L --d Authwree-ttrim�iat.teP,n hhre•o: nu:nu- -d ASM to sign this San Joaquin County Well & Boring Permit Application on my behalf. 1 understand this authorization is valid for one year and is limited to the work plan dated on the front page of this application.. f•IL7Ptr•151�1':5.201- P.,— ,f] W911 l htup Pinot K e0Z: I I ZZ IZ deS