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<br /> 9 ADDRESS: - } / Me PERMIT#:
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<br /> 1,the Owner/Applicant/Licensed Well Ddher/Pump Contractor agrees to Indemnify,distend with counsel reasonably approved by County,and hold harmless
<br /> the County and tis officers,officials,employees.agents,boards,and commissions(eolleciveiy'County)as follows:
<br /> 1. Indemnity:
<br /> a. From and against any and all claims,demands,actions,proceedings,lawsuits,losses,damages,judgments andlot 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 /> pan,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 teas 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 paniclpabe or dared the defense of any Clain.The County's actions in defense of any claim shalt not relieve me of any
<br /> obligation to Indernnify,defend,and told harmless the County.
<br /> b. In the event of a disagreement between County and me regarding defense of any Claim,the County shail have the authority to control
<br /> the litigation and make litigation declsions,including,but not limited to,the manner M 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 fall 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 the County Counsel or employ
<br /> separate outside counsel to represent or defend the County,and I snail pay the reasonable attorneys'fees and costs of such counsel.
<br /> t 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 IFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br /> WORKERS COMPENS N LAWS.
<br /> PROPER � /� ��
<br /> S(GN: PRINT:]+G`+V'�- /'�to" DATE
<br /> Licr,Nsm WELL DRL.L UMP CO.rrRACrOR:
<br /> $IGN: fa�r��[t•- PRINT_
<br /> —Iq It,r N c)r t S c n1
<br /> DATE
<br /> AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br /> 1, ,hereby authorize
<br /> Name on C,37 lkm»d AalFurt2e0 NrpresaaaN,v Pin flame M AuOur,nd Apo,
<br /> to sign this San Joaquin County Well&Boring Permit Application on my behalf:1 understand this authorization is valid for one year and
<br /> is limited to the work plan dated on the front page of this application.
<br /> I uawr x t yssnm r PW 2 or 2
<br /> u'w wav,Pumu
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