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317E ADDRESS 9 75 /2iG�UIYD QST GTQ/� PERMIT #: 1, the Owner/ApplicantlUcensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless the County and its officers, officials, employees, agents, boards, and commissions (collectively 'County ) as follov-,s: 1. indemnity: a. From and against any and all claims. demands, actions, proceedings, lawsuits, tosses, damages, judgments and/or liabilities arising 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 for permit by the County, and any environmental review documents related to the applied for permit,, b. For any and all costs and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited by law, including but nct limited to damages, costs, expenses, attorneys fees, ar expert witness its that may be asserted by am} person or entity, private attorney genterai fees claimed by or awarded to any party against the County, and the County s costs incurred in preparing an administrative record which are not paid by the petitioner. C- Except as to the County's sole negligence or wiliful misconduct. 2. Defense: a. The County may participate or direct the defense of any Clam- The County's actions in defense of any claim shaii rot relieve me of any obligation to indemnify, defend, and ho'd harmters the Co:�ty. b. In the evert of a disagreement between County and me regarding defense of any Claim, the County shall have the authority to control the litigation and make litigation decisions, including, but not limited to, the manner in which the defense is conducted. If Courty reasonably determines that having common counsel presents such counsel with a conflict of interest, 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 utilize the Office of the County Counsel or employ separate outside counsel to represent or defend the County, and I shall pay the reasonable attorneys' fees and costs of such COL. -ns -el. I HEREBY CERTIFY THAT I HAVE PREPARED TMS APPLICATION AND -1HAT THE WORK WILL BE DOVE 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 1 AM IN COMPLIANCE WITH ALL I.NORKERS COMPENSATION LAWS. PROPERTY t)'."tNER: SIGN: -- PIZINr: DATE _. L[c nsED %V C.ONTR r_rou: / /j� 2s SIGN PMNT:,L' 7L -71F DATE AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMrF APPLICATION I , hffcbr aaftrize 7:;cxf(157 i.tc:�1is33.ie73 �tz�£ 2:z=..;rs'a .. =.r+ �r:•�:,: ✓:..i hs_c to sign this San Joaquin County Well & Boring Permit Application on IM behalf.' I mxlerstand this authorization is valid for one year and is limited to the work plan dated on the front page of this application.