|
'.Jk'
<br />it
<br />ADDRESS: DDRESS: 4 t ,� CI r -,i e S� h �-7
<br />' —1 �� � ' r/ PERMIT
<br />Plot Plan:
<br />I, the OwnerlApplicant/Licensed Well Driller/Pump Contractor agrees to indemnity, defend with counsel reasonably approved by County. and hold harmless
<br />the County arid 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 out
<br />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 part,
<br />approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for permit:
<br />b. For any and all costs arid expenses inctured by the County on account of any Claim, except where such Indemnification is prohibited by
<br />law, including Uut not limited to damages, costs, expenses. attorney's fees, or expert witness costs that may be asserted by any person
<br />or entity• private attorney general tees claimed by or awarded to any party against the County, and the County's costs incurred in preparing
<br />an administrative record which are not paid by the petitioner.
<br />c. Except as to the County's sole negligence or willful misconduct
<br />Defense:
<br />a. The County may participate or direct the defense of any cairn. 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 conlrol
<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 it I fail to promptly assume the defense of
<br />any Claim or to promptly employ counsel reasonably satisfactory to the County, than County may utilize the Office of the County Counsel or employ separate
<br />outside counsel to represent or defend the County, and I shall pay the reasonable attomeys' fees and costa of such counsel.
<br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN
<br />COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND
<br />ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS
<br />COMPENSATION LAWS.
<br />PROPERTYOWNER:� �.
<br />SIGN ,.�) %t t L = `ice, ! PRINT. : i'f ! . t I k t' C (_ DATA_ G
<br />I.rCFNS£DWELLDR TMPC01\TRICTOR:
<br />SIGN: � :�, PRINT. ,,' 1 t r N cyc r` 1 S Co ;'Ni DATE _
<br />AUTHORIZATION FOR OTHER 11 IAN C-57 SIGNING PERMIT APPLICATION
<br />l , hereby authorize
<br />t�aT n{ c' -S7 �.en=.d w„ Ih,.n<ee Rerraenm. el 1 Prim Nome of Authorl[e0 Agar)
<br />to sign this San Joaquin County Well & Boring Permit Application on my behalf, f understand this authorisation is valid for one year and
<br />is limited to the work plan dated on the front page of this application.
<br />EHO 43-08 WELL DESTRUCTION PERMIT
<br />11/23/21
<br />
|