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-n -0 p (A <br /> = v C <br /> Om m <br /> N 0 rn Q <br /> n O -Q <br /> o 00 <br /> C:) <br /> N Z N <br /> C) (D N —4 <br /> N � � <br /> O <br /> � � W <br /> N = <br /> M <br /> < � N <br /> O 17- <br /> :Z1 a a <br /> 3 c 2' <br /> C7 <br /> Q, D <br /> - � m <br /> = a N) <br /> N <br /> CD <br /> CD <br /> r-r• O <br /> 3 O <br /> —0 JDRESS: .ti,_ PERMIT#: <br /> (D <br /> A Plan: C <br /> N <br /> F <br /> O <br /> W <br /> N <br /> n1 <br /> 3 <br /> Q <br /> n <br /> ID <br /> t 3 <br /> t <br /> V <br /> Lorgitlbe: <br /> to indemntly,defend with counsel reasonably approved by County,and hold harmless <br /> [nude: Conl2dts or agrees missions colbctively County)es follows: <br /> GIS Coordinate:La nllerlPump boards,and_.- _� <br /> lica,1L,censed I Employges,agen..�•,_ —` <br /> t,the OvmedApP officials, Tions.proceedings.lawsuits,losses,damages,Judgments andlor IlabiGtlas arising <br /> the COUnty arm and ell dalm5,demands.lie I ed for Well of pump or to attack,set aside,void,or annul,In Whole I, In <br /> a ainstoa In ronnadlon with the sPPli it by and app <br /> From and 9 for Permtt by the County,and any environmental review documents rotated to the applied for <br /> a' related to, the applied <br /> out o4 approve or denial of <br /> part mad by the County on account of any Claim,except where such Indemnification is prohibited <br /> permit; is a^d expenses incu co'the expenses,attorney any <br /> or expert witness costs That may be asserted by any <br /> ed <br /> b For any and all cos <br /> by law,Including b vta°e altomey g ot IIMIdamages, <br /> led 1.edamag sse naompa'id by the D awarded <br /> to any party against the County,and theCounty's coats ncurt <br /> perso^or entity.P <br /> In preps <br /> ting an administrs tisv°ernEgi 9 ne or vnnful misconduct. <br /> c. Except as to the CountyClaim The County's actions In defense of any claim shell not relieve me of any <br /> may Participate or dire the defense of any County 2 Defense: defense of any Claim,the County shall have the authority to control <br /> a Tho County delond,and hold harmless the runty. <br /> reement between County and me regarding <br /> obligation to indamnify, s Including,but not limited to,the manner d interest,or it Ithe defense Is fall t°promptlyucted <br /> assume the defense of <br /> b_ In the evert of a s litigation decislo^ rants such oounsel vAth a°O may udllze the Office of the County Counsel or employ <br /> common counsel p to the County,"hon County <br /> the termine,Iheigation an t having ea sabsfacd I s <br /> delenn rpunsel reasonably and I shall pay the reasonable eltemey5'fees and costs of such counsol. <br /> If County reasonabl ptf I employ THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> any Claim or to P resenl Or defend the County.an <br /> AND <br /> any Clal.e outside counsel to reP PREPARED <br /> THAT 1 HAVE D RULES AND REGUL CEINSE BOARD AND THAT TONS t ALSO CERTIFY HAM INAT COMPLIANCE REQUIRED LICENSE <br /> All <br /> CERTIFY ORDINANCES,STATE LAWS,Af'I <br /> I HEREBY <br /> COU OS WITH THE CALIFORNIA CONTRACTORS STATE <br /> CURRENT AOMPENS TION LAWS / y, Dnie�--- <br /> WORKERS PRIM: <br /> PROPERTY OWNER: 1 I� <br /> DATE U'i L y <br /> .EI✓P MP °MMR°li: PRINT: 5 (D <br /> SIGH: 0 <br /> uceraev wet) G pERNIIT APPLICATION <br /> FOR OT R THAN C 57 SIGNIN Q <br /> SON: HORIZP'TION ' Aw <br /> A� hereby authorze r,wHuro° <br /> (D I„a xq° I ermit Application on my behalf'1 understand this authorization is valid for one year an � <br /> �,u,K CC <br /> J37 my ell ont Page of this.application. p , <br /> this Sano Plan dated ov ul► � <br /> to sign the work p' S O <br /> N is limited to rw�°rT O <br /> •A <br /> W <br /> N <br /> wfp"rd Ionfrsoti �, <br /> CO <br />