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SITE ADDRESS: PERMIT#: Plot Plan: 0. GIS Co&ittiate:Latitude: Longitude: 1,the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify,defend with counsel reasonably approved byCounty,and hold harmless the County and its officers,offimals.employees,agents,boards,and commissions(collectively"County^)aofollows: 1. Indemnity: a. From and against any and all claims, damends, actions, proceedings, |uwmu8a. |vowoo, uomogoo, judgments and/or liabilities 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 in part, approval or denial of the applied for permit by the county, and any omxmnmoma| review documents related to the applied for permit; b. For any and all costs and expenses incurred by the County on account of any Claim, where such indemnification is prohibited by law, including but 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 party against the County,and the County's costs incurred in preparing an administrative record which are not paid by the petitioner. c. Except asmthe County's sole negligence o,willful misconduct. 2. Defense: a. The County may participate or direct the defense of any ClaimThe County's actions mdefense of any claim shall not relieve memany obligation uvindemnify,defend,and hold harmless the County. b. mthe event o[adisagreement ueweanooand me regarding defense of any Claim,the County shall have the authority to control the litigation and make litigation decisions,including,but not limited to,the manner in which the defense is conducted. If County reasonablydetermines that hi |presents such counsel,wd`a conflictofinterest,orn|b,i|u,promptly assume thedefense of any Claim or to promptly employ ouunoo| reasonably satisfactory to the County, mon County may utilize the 0noo of the County Counsel or employ separate outside counsel to represent or defend the County,and I shall pay the reasonable attorneys'fees and costs of such counsel. | MsmEB7 CERTIFY THAT | HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE oOms IN aoCORo4mCs WITH SAN JOAQuN COUNTYAC CURRENT C CSSTATE LAWS, AND RULES AND msmuLAT|Omo ALSO'aO CEmT|FYT*AT MY RsQu|mso LICENSE IS ITH THIE I*LIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL PRO E I IRAE �?rOR WATER EXTRACTION WELL ON PRIVATE PROPEIY): SIGN PRINT: DATE SIGN: PRINT: AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION l hereby authorize Name"ruv,Licensed Authorized Representative Print w=°°,Authorized Agent to sign this San Joaquin Conzt/WeU8tBorin0PeroitApplioud00000g'6ohalfluodcratanddhieuuduorizutiooiavu6d8broonycazood ialimited tothe work plan dated uuthe front page oythis application.