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�iTE ADDRESS: -1lL 1 �l/�V Pd / /'lJ!/ Vr'lr//D PERmT#: <br /> Plot Plan: <br /> I I i i I iIJ <br /> I <br /> -16 wordinate L nude: <br /> I ir*Owner1APVhcatu+ltc@ m Mr Ei'tiat ID kdMtaity,dslend wkh CDtlrief reasonably aW,-,vsd by Camty,and hoid hiemiM <br /> the County and"officers offiefale,Is C%VE/k jgob,ttolyda.tad ootT+lnissions(Cd1°etiaely�Counfyr as fotpows <br /> 1 IrxiernnRy <br /> From,and against arty&W*clam detmanda.acbona.Crooesdinps.lawriwts trans damaQac ludganerds ala!•or xatvit ea ane+n9 <br /> a:t of.related tD,or in aasud(Dn VAM the appef akn and aim lbr well of p n%p or to shack.eat aside,void,or anmuf,in MAmte or in <br /> part. 3;pro ei or donut C#ft ipPW for panful by the County.and any wyironrrRntA review dOCUMOnts*Wad to the apptiey fa' <br /> pertra. <br /> b For any and ail Costs a c experwn incurred Dy the CcuWy cn account of airy Ctsrn.except*trere such ndsnr4osian is Vu h6hDd <br /> Dv la*.eccli+dn9 out not hm ad 10 damages.coati,expenses.aoorrwy's tees.or expert vgv*ss casts chat may,be Mmftd try any <br /> DW30n or emttfy.pmste eno" y 90WO low ctairned Dy or awarded to any party against the Cawnty,and thin CocxWs costa he rfad <br /> -n prepannq an admns08tive record uTMiCh tea not paid by the netitsoner <br /> c. Except as to the Cotmty's We negilgenca or vARul mi5cond.nct. <br /> _ Derense <br /> a. the County Rhal'P&MCrpale or dreat ens defense of any Claim.The County s aetcins;n defense d any claim s'hali not rvMve me of any <br /> otaganom to it dsrynVy,detend,and bold harmless the County. <br /> o kn the event of a aeegree r mint bob~County and me regarding defense of any Claim,the C:wrYy shall have the authotay to cowro; <br /> the Wgsdon a --ft eion idsid lone,kwAiding.twt nut limited to.the mnan In va ae nef rch the defbn is Cunducte:. <br /> te3S�nattly detertrtfrlet ti]R ZoMe n eoumel presents such Coups i weh a comfkt o'irterest-or if 1 tallrn to Xoptty assume tta defense of <br /> n y Clarr of toPMvPdy empiby p�lli rteetn@My seiefaCby to the COUrrty. Shen COWty may trtEre the O#ke o+th Crwnty Counsel or empkny <br /> :.a:>.7r41e JUISde ccxslsel to repreattrlter -i I t 'the County,end 1 shall Pay',he reasonable a=wleYs tees and to6ts at suer,caunset <br /> I HEREBY CERTIFY THAT 1 HAM f►Ittti #JdEo THIS APPLICATION AND THAT THE WORK WILL BE DONE M ACCORDANCE WnM tSAN <br /> JOAQUIN COUNTY ORDO A MS. STAVE LAW^ AND RULES AND REMLAT"W' 1 ALSO CUM" THAT MY MMRED Lowlise is <br /> CURRENT AND ACTNE WRH TIM CALrORIMA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM W COWLIANCE WrrN ALL <br /> WORKERS CONPENSATHM LAWL <br /> Pr OP"TYOwpEN(SIG"TL11!is r"WA, DtTRACTWN WELL oar PRIVATE PROPOrT* - <br /> SION: V Pfr.rr >11�2 TAhI/'A� `; ti OAT. C� i`- <br /> _ l D+ tt <br /> l n c1%>rD Vylu. DATE <br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br /> __.._ Yes of C•TT Las6:wYs1d f��r01�t hn!ia:f A:�L+nd.�l <br /> slim this Sfln Ioagtil Cglnty Wdl&Boring Pc mtt Applx;ation un-Ln, behalf.I understand this sutharization is valid for one year and <br /> i,tntl%;d to the work phro dated oa dic f ml.pray of thus application <br />