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SITE ADDRESS: 700 Yosemite Ave., ESCalon PERMIT#:
<br /> Plot Plan:
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<br /> GIS Coordinate:Latitude: A 7 7gRA2 _ Longitude:
<br /> I,the Owner/AppkcanULicensed Well DrillertPump 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(cogbctivety`County')as fugaws.
<br /> 1. Indemnity.
<br /> :n: a. From and against any and all claims,demands,actions,proceedings,lawsuits,losses,damages,judgments and/or liabilities arising
<br /> ing
<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,c(sts,expenses, attomey's fees,or expert witness costs that may be asserted by any
<br /> �t person or entlty,private attorney general fees claimed by or awarded to any party against the Coun
<br /> ty,and the County's costs incurred
<br /> in preparing an administrative record which are not paid by the petitioner.
<br /> C. Excerpt as to the County's sole nbpligance or willful misconduct.
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<br /> 2. Defense:
<br /> a. The County may participate or direct fhe defense of any Claim.The County s actions in defense of any claim shall not relieve me of any
<br /> #. r obligation to Indemnify,defend.and hold harmless the County.
<br /> Nr gym; E` 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 /> It County reasonably determines that having common Counsel presonls suet)counsel with a conflict of interest or if I fail to promptly assurse the defenses 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 shag pay the reasonable attorneys'fees and costs of such counsel.
<br /> 1 HEREBY CERTIFY THAT 1 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS
<br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL
<br /> WORKERS COMPENSATION LAW —�
<br /> PROPE
<br /> SION: \ ----'_"` PRINT:_ `�\ DATE 1" 2 -
<br /> ,_. LICENSED WE/I.DWLLEWPUMP C RACTOII: 5 by ail Roddy
<br /> S*N: b a`r PRINT: Henrings sus. Drilling Co. DATE 11-22-22
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> Ni�n,e ofe.5�r xeuxd A,YA.rrrcd kenrcrma6r Prna Ntmc ui A,yA�1 AK.a
<br /> ?- to sign this San Joaquin County Well&Boring Permit Application on my bebalf.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. Ans . ;
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