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SITE ADDRESS: /�t1v1 tel! V, L/ t� L "1 PERMIT#:
<br /> Plot Plan:
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<br /> 19
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<br /> GIS Coordinate:Latitude: Longitude:
<br /> 1,the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify,defend with counsel reasonably approved by County,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 claims,demands,actions,proceedings,lawsuits,losses,damages,judgments and/or liabilities ansing 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 preparing
<br /> 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 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 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 JOAQAN
<br /> UIN
<br /> RENT D
<br /> ACTIVE ORDINANCES,STATE LAWS, AND RULES AND THE CALIFORNIA CONTRACTORS ATE LICENSE NBOARD SAND THAT I AMO CERTIFY THAT MNRCOMPLIANCE EQUIRED EWITH NSE SALL RWORK RS
<br /> COMPEN N
<br /> PROP! PRINT: '`G 1 W��[L1Y�— DATE
<br /> SIGN:
<br /> LICENSED L 'R/PUMP CUNT UR: \ r`�}{ �J►n�,{,'I,� DAA
<br /> PRINT: �\`/�1' 1.1 Vl Q V
<br /> SIGN:
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> 1 ,hereby authorize
<br /> ((prim Name of Authorized Agem1
<br /> (Name of C•57 l.iansed Aythorced p:eprevemnivel
<br /> to sign this San Joaquin County Well &Boring Permit Application on my behalf.I understand this authorization is valid for one year an
<br /> is limited to the work plan dated on the front page of this application.
<br /> WELL DESTRUCTION PERMIT
<br /> EHD 43-08
<br /> 11/23/21
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