|
SITE ADDRESS: 41 S W— Lwk _ PERMIT#:
<br />I, the OwnerlApplicant/Llcensed Well Orilleu'Pump Contractor agrees to ,ndemnify, defend with counsel reasonably approved by County, and hold harmless
<br />the County and its officers, of£c als, employees, agents, boards, and commissions (collectively 'County') as follows
<br />Ind emn 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 imiled to damages. costs, expenses, attorney's fees or expert witness costs that may be asserted by ary
<br />person or a^lity, 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 Witch 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 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 lit gation 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 tall 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 1 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 15
<br />CURRENT AND ACTIVE WITH THE CALIFORNIA t�RAC RS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br />WORKERS COMPENSATION LAWS,
<br />PROPERTY OWNER: ',/`�
<br />SIGN: _ — — _ PRINT: �! '9 ,_. ._.. --- DATE
<br />7 -- ----
<br />LICE\'SED NNTU, DRILLERL PUMP CONTRACTOO: -_
<br />SIGN:
<br />PRINT: DATE
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />I, hereby authorize
<br />?4anm of C -Sl Lk -1 Awl.dved Rpl—ftiiiir P�,nl Nen, , I A,0, 6" A%trt
<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 />! WXA)-76 RSA=?1 iC2'i. P_;.- - Wc1I P.",r Pmmi
<br />
|