Laserfiche WebLink
f <br /> r L; <br /> SITE ADDRESS: � Eli1 t Ci T7 11 ,7 PERMIT <br /> Plot Plan: <br /> � T <br /> CM <br /> 74 <br /> { i <br /> f l <br /> i <br /> Ld <br /> I I i 1 <br /> I 1 i <br /> � r <br /> - — <br /> I i <br /> GIS Coordinate Latitude _ __. Longitude: <br /> !z <br /> 1,the Owner/Applicari Licensed Well Driller/Pump Contractor agrees to indemnify,defend with counsel reasonably approved by County,and hold harmless <br /> the County and its oficers,officials,employees.agents,boards,and commissions(collectively'County')as follows <br /> 1 Indemnity. t <br /> a. From and against any and all claims.demands. actions,proceedings,lawsuits,losses,damages-judgments andlor liabilities arising <br /> out 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 <br /> part, approval or dental of the applied for permit by the County,and any environmental review documents related to the applied for <br /> permit; <br /> b. For any and all costs and expenses incurred by the County on account of any Claim,except wt ere such indemnification is prohibited <br /> by law•including but not limited to damages,costs,expenses,attorney's fees,or expert witness costs that may be asserted try any <br /> person or entity.private attorney general fees claimed by or awarded to any party against the County.and the County's costs Incurred <br /> in preparing an administrative record wfdch are not paid by the petitioner. <br /> c. Except as to the County's sole negfigerce 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 at any Claim,the County shall have the authority to control <br /> the litigation and make litigation dec sions.including,but not limited to,the manner in which the defense is conducted <br /> It County reasonably determines that having common counsel presents such counsel with a conflict of interest,or N I tad 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 <br /> separate 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 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERSC �nLA�WS ..,PROPERTWELL ON PRNATE PROPEA"* / �J�t � ,S:. PRINT: ,V Y� '"-r`Y'...^`."� DATE Si-il'1Z <br /> I,lCF.NSkV�1VELjL DVLtXRMV.%4P <br /> CONTRACTOR! <br /> SIGN: lJ L�'t!'•rt'� PRINT: 1 L r'� f S t:'Y 1 DATE r <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> ( hereby authorize <br /> 1,r.a:.f C 41[%'c k.,—i.uitnmerd xenie.'>z+Ii•� rr„a.,me ur e Aii— <br /> to sign this San Joaquin County Well&Boring Permit Application on my behalf.t 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 /> I <br /> CriCltl4.fu668ii7rltlT2 Pays2M2 Well/AIxnP Pamu <br /> I <br />