|
SITE ADDRESS: 7761 W Undine Road, Stockton, CA 95206 PERMITM &Dq�o
<br /> Plot Plan:
<br /> 4*fl
<br /> GIS Coordinate:Lafitude: 37'4552.33*N LOngftUde:121"24'28.62`W
<br /> I,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 attomeys'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, 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 /> PROPENERISIGN. /{ ,A(A 7lot4VG_oy
<br /> PRINT: 99W 0/LIi0414,44) DATE
<br /> LICENSED FELL DRILLER/PUMP CONTRACTOR:
<br /> -" ,M°,,,'so-a Robert"Tony" Martin, PG, 0-57 RM61, 3/2/2022
<br /> SIGN: l�(11lPYt A Iivila�we^�"""'<�°a`"° PRINT. Y � ��TE
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> 1, hereby authorize
<br /> Nano of C-57 L mnscd Authorised Rcpt wive Print Name of Auihoriecd Agem
<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 page of this application.
<br /> EIID043-06 10125/2021 Page 2 ore well i Pomp Perma
<br />
|