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SITE ADDRESS: <br /> 1—7 <br /> W04 Ion PERMIT#;-- <br /> Plot Plan: <br /> I I I I I I <br /> GIS Coordinate:Latitude: <br /> Longitude: <br /> 1,the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify,defend with counsel reasonably approved bCoun , <br /> the County and its officers,officials,employees,agents,boards,and commissions(collectively'County")as follows: y tyand hold harmless <br /> 1. Indemnity: <br /> a. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages,judgments and/or liabilities arising <br /> 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 <br /> part, approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for <br /> 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 <br /> by law, including but not limited to damages,costs, expenses, attorney's fees, or expert witness costs that may be asserted by any' <br /> person or entity,private attorney general fees claimed by or awarded to any party against the County,and the County's costs incurred <br /> in 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 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 Countyand me regarding defense of any Claim,the County shall have the authority to control <br /> the litigation and make litigation decisions, <br /> If County including,but not limited to,the manner in which the defense is conducted. <br /> 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 <br /> separate 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 <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AKM PC-UL-ATIC5"O.,38 AL.*O '-=MTlr'Y THAT MY REQUIRED LICENSE 13 <br /> CURRENT ANO ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE ARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> PROPERTY OWNER: <br /> -SIGN: <br /> PRINT:-LV1e&r1q1F DATE Zo- <br /> 1ACENSED ELL RMLER5KTP CON CT <br /> SIGN: PRINT:—Z;60r1 Ali 0-/<5 <br /> DATE - <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> N.— ,hereby authorize <br /> oro-s7 rs...�d Aulh.rized Repre—t.J­ MIR Name of Aud <br /> to sign this San Joaquin County Well&Boring Permit Application on my behalf.I understandthorizethisAgent authorization is valid for one year and <br /> is limited to the work plan dated on the front page of this application. <br /> EHDG43-0610/2312021 <br /> Page 2 of 2 <br /> Ivell/Pump Permit <br />