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SITE ADDRESS: ')00117 Ellis Rd., Escalon PERMIT#:
<br /> Plot Plan:
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<br /> GIS Coordinate:Latitude' �7 Longitude:
<br /> I,the OwnerlApplicant/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
<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 whero 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[he 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 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 1 AM IN COMPLIANCE WITH ALL
<br /> WORKERS COMPENSATION LAWS.
<br /> PROPERTY OWNER: _
<br /> SIGN: /1 L PRINT: DATE
<br /> LlcrwT..n��'elLUkn.t.t:RlPr�uCnvruncloR: � Se�Ill ., (iy
<br /> SIGN' Ht'nnings Bros. Drillinu Cc) n� Fen. 1, 202?
<br /> PRINT: DATE_'
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> I- ____---- -.-----—___ -- hereby authorize
<br /> �„Kort'-y'tw,e.;dAnrt.nv:JRapn�,. ,. Itn,:rx,nr,ra.u..,„;.inr:,,i
<br /> to sign this San Juayum County Well k Boring Permit Application un my behalf. I understand this authorization is valid forotic year and
<br /> is limited to the work plan dated on the 11.0111 page of this application.
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