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SITE ADDRESS: 15465 E. French Camp Rd., Ripon PERMIT #•
<br />Plot Plan:
<br />GI
<br />Longitude:
<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 out
<br />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,
<br />approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for 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 by
<br />law, including but not limited to damages, costs, expenses, attorney's fees, or expert witness costs that may be asserted by any person
<br />or entity, private attorney general fees claimed by or awarded to any party against the County, and the County's costs incurred in preparing
<br />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 separate
<br />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 JOAQUIN
<br />COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND
<br />ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS
<br />COMPENSATION LAWS.
<br />PROPERTY OWNER: T (� 4 Q
<br />SIGN: n PRINT: 1 � C DATE A - C!
<br />LICENSED WELL DRILLER/PIJMP CONTRACTOR: Sean Roddy
<br />SIGN: 4 m hr: tj.6A0d. Din►,�Y S IL PRINT: Hennings Bros. Drilling by DATE Aug. 8, 2022
<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 />EHD 43-08 WELL DESTRUCTION PERMIT
<br />11/23/21
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