Laserfiche WebLink
220Y �l AWSITE ADDRESS: �I -�N N �Cal ON ,V PERMIT#: <br /> Plot Plan: <br /> A 411 <br /> I I <br /> GIS Coordinate: Latitude: Longitude: <br /> I,the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnity,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 arising 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,attorneys 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 JOAQUIN <br /> COUNTY ORDINANCES. STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND <br /> ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS <br /> COMPENSAT S. <br /> PROPERTY Dj�&MdN <br /> 1�SIGN: PRINT: DATE 1 114) <br /> LICE\SF:D LEH/PI\1P t0\1'R.\' A V I! I� <br /> SIGN: PRINT: \'�J'�11� DATE / <br /> AUTI IORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> 1, hereby authorize <br /> i Namc of C-n Lrcn of Authrcv d H�xcuMan.ri (Pnn Namc nt Aufh,n;W AgInt, <br /> to sign this San Joaquin County Well & Boring Permit Application on my behalf. 1 understand this authorization is valid for one year and <br /> is limited to the work plan dated on the front page of this application. <br /> EHD 43-08 WELL DESTRUCTION PERly <br /> 11!23/21 JA <br />