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SITE ADDREBS: <br /> PERMIT#: <br /> Plot Plan; <br /> I <br /> I <br /> j <br /> l ' <br /> i <br /> I � I <br /> II I <br /> I <br /> GIS Coordinate:latitude: <br /> Longitude: � <br /> I,the County <br /> and its face sensed W.employees, 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 <br /> out of,related to,or in connection with the application and applied for well or pump or to <br /> permit; attack,set aside,void,or annul,in whole or in <br /> part,approval or denial of the applied for permit by the County,and any environmental review documents related to the applied for <br /> b. For any and all costs and expenses incurred by the County on account of any Claim,except where 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 by 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 which are not paid by the petitioner. <br /> C. Except as to the County's sole negligence or willful misconduct. <br /> Z• 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 a <br /> obligation to indemnify,defend,and hold harmless the County. ny <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 <br /> separate outside counsel to represent or defend the County,and I shalt 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 WITI4 SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWs. Arlo PULs0 nrmrs Re¢uuarlomvs. I ALGQ 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 /> WORKERS COMPENSATION LAWS. <br /> PROPERTY O ERn { ' <br /> SIGN: <br /> DATE <br /> LrcEtvsEU� LLD '#rP <br /> ON}T�RA $: <br /> 31GN PRINT' 45C <br /> — DATE <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> Aamc orc-57 Limued Aulhotucd R ----`---hereby authorize <br /> epr6etll0llve ---Name-rA U-rizedAgem <br /> c sign this San Joaquin County Well&Boring Permit Application on my behalf.I understand this authorization is valid for one year and <br /> i limited to the work plan dated on the front page Of this application <br /> Boas-o�Iansapn <br /> Page 2 of <br /> we"/Pump PamL <br />