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••-ESS: 1501 Hollenbeck`• Stockton,CA95215 PERMIT #:1 <br />■..■■.■■■■■.■■■.■n■■.................■..... <br />......■..■.. ■�■.■.■.....■■..■.■■.■■■.■■ <br />■iii■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■ LION ■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■Eos■.■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■�l1■■■■■■■■■■■ ■■■■■■■■■■ <br />.■.■■....■■.■..■■■...d.■■...■...■■..■..■.■ <br />■... <br />...................■.�...�...........IS M <br />ON <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />■■■■n■■■■■■■■■■■■■■■■■■■_■■■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■ Ma. ■■■■■ ENE ■■■■■■■n■■■■■ <br />■■■■■■■■■■■■■■■■■■n■n■■■■■OMEN ■MIEN ■■■■■■■■■ <br />■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■m■■mn■■■■ <br />■■■■■■■■■■■■■■■■■� <br />■■■■■■B ■■■w■■■■■�■©�:,�:r�Et��t��i <br />n■■■■■■■■■■n■ ■■■w■:=■■■SOMEONE ■■■wMONO <br />■■■■ <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 attorneys' fees and costs of such coungel. <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 />PROPERTY OWNER: / % j�r (� / ) n` <br />SIGN: (/ PRINT: �/ (/ l/��f ,(�Vj/( DATE <br />LICENSE ' L DRII LE1/Pump CONTRACTOR: <br />SIGN:-eG PRINT: DATE <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />I,� ,hereby authorize <br />Name of C-57 Licensed Authorized Representative -" Print Name of Authorized Agent <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 />EHD043-06 10,"_5/2021 Page 2 of 2 <br />