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Docu&6n Envelope ID:OFD9CBCE-OBD9-467B-AB19-2DDL)9165FEC6 <br /> ................ <br /> SITE ADDRESS: <br /> ............... .................... <br /> Plot Plan., <br /> T-T-T......... <br /> I "' ­i <br /> I IT It <br /> ... ------- <br /> -4- <br /> T <br /> GIS Coordinate,Latitude Longitude ... <br /> 1,the Owner/Applicantll-;censed Well Drilleril"ump Contractor agrees to Indemnity,defend with counsel reasonably approved by County.and hold harm,less <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 iiabillities 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 where 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.I <br /> al, The County may participate or&rect 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 1 fail to pfornotty 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 <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 I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> DocuSigned by: <br /> Pit PERTy QWNER i NATURE is REQUIRED FOR WATER EXTRACTION WELL ON PRfVAT DATE <br /> PROPERTY): <br /> I PRINT; Zejandra Perez 2/8/2024 <br /> SIG I <br /> 1?1% ONIRACIOR. <br /> :_ <br /> PRINTDM(+ <br /> SIGN: fill a.ATE—L I <br /> AUTHORIZAVION f-'ORO'fill:;R 'IIIANC-57SI(iNIN(i PERNMITAPPLICATION <br /> hereby authorize <br /> IMM Nrof ka."Uw kom <br /> to -W this San Joaquin County Well&Boring Primit Application on my behalf.I understand this authorization is valid lbr one year and <br /> is limited to the"ork plan dated on the front page of this application. <br /> 11W "I'Z <br />