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SITE ADDRESS: _VIM_ Will, PERMIT #:
<br />I, the Owner/Applicant/Llcensed Well OrillerlPump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless
<br />the County and its officers, offic als, employees, agents, boards, and commissions (collectively "County") as follows
<br />1 Indemn ty.
<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 proh bited
<br />by law, including but not imited to damages, casts, expenses, attorney's fees or expert witness costs that may be asserted by ary
<br />person or e9lity, 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 wilful misconduct.
<br />2 Defense:
<br />a. The County may participate or direct the defense of arty Claim. The County's actions in defense of any claim shall not relieve me or 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 lit gatlon and make litigation decisions, Inc uding, 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 fall 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 counse to represent or defend the County, and I shall 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 WITH SAN
<br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, A RULE AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS
<br />CURRENT AND ACTIVE WITH THE CALIFORNIA C.0fqTRAC RS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br />WORKERS COMPENSATION LAWS.
<br />PROPERTY OWNER: ++11y� l,�
<br />SIGN: _ I // PRINT:_ 1 y� mal r j� 1 T --- DATE f 7 i
<br />LICE,%sEt) WFLL DRILLEWPW11P COrYTRACTO9 -.
<br />SIGN:
<br />PRINT: DATE
<br />AUTHORIZATION FOR OTHER'THAN C-57 SIGNING PERMIT APPLICATION
<br />I, , hereby authorize
<br />Nome of C.37 Lk,d AWN11ino1l ri-a Novi—4 A, -IN riull Agcnr
<br />to sign dills San Joaquin County Well & Boring Permit. Application on my behalf. I understand this authorization is valid for one year and
<br />is limited to die work plan dated on the front page of this application.
<br />E11IXM3-D6 100512021 P-;.- 1V,11 Pana, 9'umil
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