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SITE <br />ADDRESS: ;Z03-73 <br />Plot Plan- lel/ <br />PERMIT #; <br />is--tetr„ppllcant/Llcensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, <br />the County and its officers, officials, employees, agents, boards, and commissions (collectively "County") as follows: and hold harmless <br />L 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 />perm it; <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 cos <br />in preparing an administrative record which are not paid by the petitioner. ts incurred <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. sume the d <br />If County reasonably determines that having common counsel presents such counsel with a conflict of interest, or if I fail to promptly asefense 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 emploof <br />y <br />separate outside counsel 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. 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 COMPE LAWS. <br />PROPERTY OWNER: <br />SIGN: � 1 � �'` } <br />PRINT:n4YI h �� iP� DATE -7 -G -- Zc,2 <br />SIGN: � <br />LICENSED ELL b , nn� g, Co �� x: <br />PRINT:—Z; 60n p �GJ S DATES:27_=ZQZ�7- <br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION <br />r, <br />Nems crc— Lic-- —.mea Representative , hereby authorize <br />em <br />to sign this San Joaquin County Well & Boring Permit Application on my behalfPInunderstuand 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 10/25/2021 <br />Page 2 of 2 <br />Well / Pmnp Pertuit <br />