Laserfiche WebLink
1 <br /> SIVE ADDREss 250 Maple Ave.. Ripon, CA 95366 pEtmm 0: <br /> Plot Plan: <br /> 1 <br /> LA <br /> ! I I I <br /> I <br /> I <br /> s i <br /> i <br /> I i <br /> j <br /> I I <br /> i I I I <br /> j <br /> GIS Coordinate LW tude..�7 7d 1 1 S Longlfude -121,13155 <br /> I,the 0wno•1AppbcanULrcansod WON Onaer/Pump Conusctor ogress to indemnity.defend vn!h counsel reasonably approved by County.and hold harmless <br /> trio County and Its orticors,o.M.caats,amptoyees.sgents,boards,end co rruss+ons(WloWvely•Co -Y)as follows. <br /> 1, Indommty <br /> a. From and against any end al claims.dornands,ecticns,procoed".lawsuits.losses,damages,judgments andlor taabl tIes anslrg out <br /> of,related to,or 1n conneCion*Ain the application and applied for well or pump or to atledt,sot aside,vrrid.or annul,1n vehote o in part. <br /> approval or Con al of the 90o'1ed toe permit by the County,and any environmental review docurnents rotated to the applied lot pwTrat <br /> b. For any and as costs and oxw.ses Lncurred by the County on account of any Calm,except where such hdornntfic0on Is prohibited by <br /> law.including lou;not GrnRed to damages.costs,expenses,attomey's fees,or expert wrness costs that may be asserted by any person <br /> or entity,pnva!o aromey gerwral leas claimed by or awarded to any party agairs!the County,and the County's costs recurred in preparing <br /> an admin-s"t.ve record whlrh are not paid by the pabboner. <br /> c. Except as to the Co rys sok negligence or wNthd miscondueL <br /> 2. Dole-Ise <br /> a. The County may pafticlpate or diett the defense of any Gaim The County's salons in defense of ary darn stall not relieve me of any <br /> odwatior.to indemnity,defend,and hold hannte"the County. <br /> b. In the event d e d sagreem.ent between County and me regarding defense d any Clan,the County shall have the authority to contrd <br /> the kigatw^n and make Irt.Wion decisions.Including,but not limbed Ie.the marcor in which the defense is conducted <br /> If County reasonably determines that having common counsel presorts such counsel with a eonflrt of intnresl,or If I fad to promptly assume the defe=nse of <br /> "Clam or to promptly employ counsel reasombly satisfactory to the County.then County may utize the Office of the County Counsel or employ separate <br /> outs;de counsel to repraserl or defend Vo County,and I scall pay the reasonable anoxnays'tees and costs of such counsel. <br /> 1 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 MTN THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS <br /> CONPENSAnr' PPOWT: <br /> , <br /> PRo.eRTYOWNMaria olivas 4/12/2023 <br /> SIGN: /�'11 DATE <br /> t.u�:tisroWCU.DR1t.l.(a/Pl;krrCONTRAf'TQIt: ��P' Sean Roddy <br /> SICW:H�aa . -�>z�.! p�wT: Hennings Bros Unlhnq Co. by DAT, Apr. 12, 2023 <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> _ hereby authorize _ <br /> ('40v00)1 Lar-"d Aank—Md Releona %I (ft—%&WCr Ay'V-Vac Arfnn <br /> to sign this Sen Joaquin County Well&Boring Permit Application on my behalf. i understand this authorization is valid fur unc year and <br /> is limited to the work plan dated on the front page of this application. <br /> E HD 43-09 WELL DESTRUCTION PERMIT <br /> 11123,21 <br />