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SITE ADDRESS: ' _ � ��% � PERMIT #: Plot Plan: the County and its officers, officials, employees, agentsboards, and commissions (cMIDCtively "CoLnty') as `dtio:,S. i . Indern ni... a. From and agairst any and all claims. demands actions, proceedings, aomuts, losses, damages. Judgments and/or liabilities ansino 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 part, approval or denial of the applied 'or permit by the Courty. and any environmental review documents related to the appl!ed for permit, b. For any and all costs and expenses incurred by the County on account of any Claim, except where such indemnification -s prohibited by law, Including but not limited to damages, costs, expenses, ananeys fees, or expert wlness costs that may be asserted by any person or entity private attorney general fees claimed by or awarded to any party against the County.. and the County's costs incurred In preparing an admmistrative record which are not paid by the petitioner e. Except as to the County's sole negligence or Wilful miscondum. 2. Defense a. The County may partcipate or direct the defense of any C;aim. The County's actions in defense of any maim shall n.^.t relievA me of any obligation to indemnify, defend. and hold harmless the County b. Ir the event of a disaareeirrent between Courdy and rye agabig deferse c` any Claim, the Corny shah have the autnomy to control the litigation and mate "gaticn decisions, including, b i l riot I;miles to, the manner in which the defense Is conducted. If County reasonably determines that having common counsai presents such counsel with a conflict of lweres,4 or if I fail to promptly assume the defense of any Claim or to promptly employ counsel reasonably Satisfactory to the County- then County may &4e the Office of the County Counsel or employ separate outside counsel to represent or defend the Canty. and I shall pay the reasorat: a attomeys' feces and costs of such counsel. 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I APA IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. PR J SIGN. PRWT� DATE LicENsm)-- - ('TUk�DATE //AzlzPRNTN`Oa AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION hereby authorize 'Jom pf r•t i 1,mawe AV ilren i Itrym'Namr P-,-'i.,v *r -41116.^.V a A4=1 to sign this San Joaquin County Weli & Boling Permit Application on my hehalf. I understand this authoti7ation is valid for one year and is limited to the work plan dated on the front page of this application. rrctx><e-" Ql i! R1,1 Ntg, , w , curs, Pu,- rwn,n