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15988 E Eight Mile RD, Linden <br /> SITE ADDRESS: PERMIT#: <br /> Plot Plan: <br /> t <br /> I '4 I <br /> Nil <br /> 1 O <br /> N � <br /> v <br /> t <br /> GIS Coordinate: e: Longitude:Latitud <br /> 1,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 <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 denial 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 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 /> 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 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 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. I 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 /> WORKERS COMPENSATION LAWS. <br /> PROPERTY OWNER(SIGNATURE IS REQUIRED FOR WATER EXTRACTION WELL ON PRIVATE PROPERTY): <br /> SIGN. PRINT: DATE <br /> LICENSE ELL LLER/ U61P OYTRACrOR: <br /> SIGN: PRINT: Paula Purviance DATE 4/24/24 <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> hereby authorize <br /> Name of C-57 Licenstd Authorized Representative Print Name of Authorized Agent <br /> to sign this San Joaquin County Well&Boring Permit Application on my behalf.I understand this authorization is valid for one year and <br /> is limited to the work plan dated on the front pagge of this application. <br /> EHDO43-06 04/07/2022 Page 2 of 2 Well/Pump Permit <br /> — nut PARTMENT <br />