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SITE ADDRESS: O MW 1 S� S v PERMIT#: Pict Plan: I LAG T GIS Coordinate:Latitude: 1•the OwnertAppficantfl-censed Well Driller/Pump Contractor agrees to indemnify,defend with cotnSel MSOnably approved by Canty,and hold harmless ttw County and its officers.officials.employees,agents.boards,and commissions(eollectively'Count7r)as follows: 1. Indemnity: a. From and against any and all daims, demands. actions. proceedings. lawsuits. losses, 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 of denial of the applied for permit by the County, and any environmental review documents related to the applied for permit; b. For any and ail costs and expenses incurred by the County on account of any Clams,except where such indemnification is prohibited by taw, including but not limited to damages,costs, expenses, attorney's fees, or expert witness costs that may be asserted by any person or entity•private attorney general fees chimed by or awarded to any party against the County.and the County's Cosigjncuned ,n preparing an administrative record which are not paid by the petitioner. C. Except as to the County's sole negligence or wiitful misconduct 2. Defense. 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 obligation to Indemnify,defend.and hold harmless the County. b. In the event of a cl sagreernent between County and me regarding defense of any Claim.the Carty shag have the authority to control the I"bon and make litigation decisions,including,but not limited to,the manner in which the defense is conducted. If County reasonably determines that having common counsel presents such counsel with a conflict of interest,or N 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 counsel. I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED UCENSE IS CURRENT AND ACTP/E,WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSA LAWS PROPERTY OWNER(SIGNA RE REIS Q$U1!gD�AR EXTRACTSON WELL ON IIINATE PWWE`KTY)' /+ SIGH: / .,...r.qj PffalT: I1w �y1% { 1 C DATE LlcessEo eLtDel Pt CoYrtucTrKe_ Per. K I C1•�Ft' �a 1 11CI DATE S►c+�, w t� �l AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION ) ,hereby authorize %moreof C-�'La�e d1Wsmmf Reprtxuaurr FM Ks 40(AmilioriiiiiiiiiApo to sign this San Joaquin County Well&Boring Permit Application on my behalf.I understand this authorization is valid for one year and is limited to the work plan dated on the front page of this application. Wei ti+br EFIDP13-06 OLO'r� hFr:Or: