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Feb -18. 2022 1:32PM Wagner dairy
<br />No. 8493 P. 2
<br />SITE ADDRESS! 25823 E Carter R• Escalon,95320 �.
<br />-lot Plan
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<br />_. -r/oLump UomracroT agrTiv., .,
<br />the Gourity, and its officers, officials, employees,agents,_ follows,
<br />Indemnity:
<br />3. From and agalnsl any and all alalms, demands, actions, proceedings, lawsuits, losses, damages, judgments and/or liabilities arising
<br />out of, related to, or in connection with the appNoatlon and applied for well or pump or to attack, flet 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 administrallve record which are not paid by the petitioner.
<br />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 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 D AC TIV WIT HE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br />WORKER MPEN TI S.
<br />PROPER O NER.
<br />SIGN:
<br />L14CENSFPELL DftMLER/PUhfP CONTRACTOR:
<br />P,� ,aq W Amen w 1?a11 Mann
<br />SIGN: -Po0Zl'TanY-IM�In,aUS, o•BSN
<br />;nstaulq'.a-Saaamenlo
<br />PRINT:, 17C -r -t i& 1V1 i�� 1 --- DATE (h�
<br />PRI Robert "Tony" Martin, (PG, C-57 RMEbATE 2/25/2022
<br />AUTHORIZATION FOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />L , hereby authorize
<br />Nome of C•57 Li %J Aurharimd RT -r Lak",o Ni Na1motAuIhorrmd ASenL
<br />to sign this San Joaquin County Well & Boring Permit Application on my behalf.) 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 />ERD043-06 1017.512021 Pav 2 art Well I Pump Permit
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