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WP0045252
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4200/4300 - Liquid Waste/Water Well Permits
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WP0045252
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Entry Properties
Last modified
3/5/2024 11:57:07 AM
Creation date
2/12/2024 4:28:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0045252
PE
4374
STREET_NUMBER
736
STREET_NAME
TURIN
STREET_TYPE
AVE
City
MANTECA
Zip
95337-
APN
19827003
ENTERED_DATE
2/2/2024 12:00:00 AM
SITE_LOCATION
736 TURIN AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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SJGOV\gmartinez
Tags
EHD - Public
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SITE ADDRESS: PERMIT#: <br /> Plot Plan: <br /> GIS Coordinate:Latitude: Longitude: <br /> I,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 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, includina but not limitp-d to riamn- --f- --enses,attorney's fees,or expert witness costs that may be asserted by any person <br /> or entity,pr warded to any party against the County,and the County's costs incurred in preparing <br /> an adminis -� hitioner. <br /> c. Except as 1 C J iisconduct. <br /> 2. Defense: 1`'\-C <br /> a. The Count! —, any Claim.The County's actions in defense of any claim shall not relieve me of any <br /> obligation t e County. <br /> b. In the ever me regarding defense of any Claim,the County shall have the authority to control <br /> the litigatioi but not limited to,the manner in which the defense is conducted. <br /> If County reasonably determine ;uch counsel with a conflict of interest,or if I fail to promptly assume the defense of <br /> any Claim or to promptly emplo, aunty,then County may utilize the Office of the County Counsel or employ separate <br /> outside counsel to represent or sonable 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 I AM IN COMPLIANCE WITH ALL WORKERS <br /> COMPENSATION LAWS. <br /> PROPERTY OWNER: <br /> SIGN: PRINT: DATE <br /> LICENSED WELL DRILLER/PUMP CONTRACTOR: <br /> SIGN: PRINT: DATE <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> I, hereby authorize <br /> (Name of C-57 Licensed Authorized Representative) (Print Name of Authorized Agent) <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 PERMIT <br /> 11/23/21 <br />
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