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'0 0 cn <br /> n O (D (D <br /> n 0 � Q <br /> C)- <br /> 0 00 —, <br /> N <br /> O <br /> O ZNa? <br /> n M N <br /> C 2 <br /> N <br /> M <br /> < N <br /> O r <br /> 3o a <br /> CD <br /> n <br /> W a D <br /> = o vT <br /> N <br /> W 'P <br /> O <br /> i CD <br /> I JDRESS: _ j PERMIT#:_ CD <br /> MEe' <br /> • A Pian: rN <br /> U) <br /> O <br /> _ GJ <br /> U) <br /> G1 <br /> CL <br /> n <br /> CD <br /> t <br /> I CD <br /> I <br /> i <br /> I U <br /> toneftude: <br /> or agra,to indemnify,defend with counsel reasonably approved by Count'and hold harmless <br /> GIS Coordinate:Latitude: and commisstom(coIt, ely County')es follows. <br /> Well DhllerlPump boards. <br /> ItcantNcensed employees,a agent.+ ,c.. <br /> s. <br /> the ,nty anpP of vials, actions Proceedings lawsuits,losses damages judgments endlor liabilities arising <br /> thB County and Its o�G°r.5 J�,�.. nds, and applied for wan or Pump or to attack set aside cold,or annul,In whole or In <br /> 1f a or In con a Icuon with th f claims.demands. <br /> a Fern and against tnst any lied for Perna by the County,and any environmental review documents related to the applied for <br /> out of,related to denial d the aPP <br /> Pan approval or tha County on account of any Claim,except where such Indemnification is prohibited <br /> p�d� all costs and e�Wses incurred t> U1 awes,attorneys fees,or expert witness costs that may be assenad by any <br /> an and but not limned to damages, a awarded to any Parry against the County,and the County's costs Incurted <br /> b. b�lawY Including general fees claim aid dl b the Petitioner- <br /> person or entlry.Private attomey Ord which 9 are not P Y <br /> In W°Pari"g an adnHa solernegat7°"G°or <br /> willful misconduct. <br /> C. Except as to the The Countys actions In defense of any Uelm shall not relieve me of any <br /> County maY Participate or direct the defense of any Ga4a <br /> 2, Defense: hold harmless the County <br /> defend,and County and me rags le defense of any Claim,the County Shall s have the authority to control <br /> a' <br /> The <br /> to indem^Iry�eemenl between fled to,the manner nlwhich the defense la conducted. <br /> a disagreement, decisions,Inducting,but not Im+ g'Rd d InUres4 w U I fall W PmmPUY assume thesal defense of <br /> b, in the event end make Iltlg°Uon I reserita such counsel wdthC umY may uWize the Once of the cC:aouunty Counsel or employ <br /> determines that having common coU��ectory to the County,then <br /> the terms on <br /> It C,ounfy f.00 to t IromPtlY°"rploy counsel reasonably <br /> If C un counsel to rep PLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> resent a defend the County,and i shell pay the reasonable anomeys'tees and coals o such counsel. <br /> any <br /> separate outside coli HAVE PREPARED THIS AP <br /> THAT I CES, CONTRACTORS TATE <br /> I ALSO CERTIFY THAT IN REQUIRED LICENSE I <br /> CERTIFY $TATE LAW$' LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> �H5098YOAQU IN COUNTY TfVE1 TH THE CALIFORNIA <br /> d <br /> TION LAWS n DATE_�- <br /> GURRFl COMP NS PRtNr <br /> WORD, LIR: DATE U..Z,_----- <br /> PWW 1 <br /> P ONTRAC70Ro PRatr: iD <br /> SON: <br /> Wcytrsenwet• D ERMITAPPLICATION 00 <br /> $jON' UTH TION FOR OTHER THAN C-57 SIGNING PAS. Q <br /> ORIZP ,hereby authorize r,i u d a" is authorization is valid for one year and _ <br /> A �f,I understaa 0 <br /> CD Pur tsr^"0"W" Welloll&I Dort <br /> Permit Application on MY be <br /> I' San Joaquin Com ryd on the front page of flilxapplication ' <br /> O sign this Ian v lilt t.. •x <br /> fD Work P O <br /> N u limited to lite tyrvors O <br /> w <br /> N <br /> Ufa til <br /> 00 <br />