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DocuSign Envelope iD: 2F5211 F4-C4BF-4908-AE62-521 DBBDED73F SITE ADDRESS: 14600 Austin Road, Manteca, CA 95336 PERMIT#: Plot Plan: I, the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless the County and its officers, officials, employees, agents, boards, and commissions (collectively "County') as follows: 1. Indemnity: a. From and against any and all claims, 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 or denial of the applied for permit by the County, and any environmental review documents related to the applied for permit; b. For any and all costs and expenses incurred by the County on account of any Claim, except where 7rohibited by law, including but not limited to damages, costs, expenses, attorney's fees, or exn-� t �� d by any person or entity, private attorney general fees claimed by or awarded to any party< c, 't ` incurred in preparing an administrative record which are not paid by the petitioner. �O D C. Except as to the County's sole negligence or willful misconduct. 2. Defense: a. The County may participate or direct the defense of any Claim. The County's actions i of any obligation to indemnify, defend, and hold harmless the County. b. In the event of a disagreement between County and me regarding defense of any ClaiDntrol the litigation and make litigation decisions, including, but not limited to, the manner in w If County reasonably determines that having common counsel presents such counsel with a conflict of intereJ _ .tense of any Claim or to promptly employ counsel reasonably satisfactory to the County, then County may utilize _..iiry Counsel or employ separate outside counsel to represent or defend the County, and I shall pay the reasonable attorneys' fees ar ziuch counsel. I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. PROPERTY OWNER (SIGNATURE IS REQUIRED FOR WATER EXTRACTION WELL ON PRIVATE PROPERTY): SIGN: PRINT: DATE ou: SIGN. PRINT: Amanda Hancock DATE 8/11/2022 UT RIZATION OR OTHER THAN C-57 SIGNI,%G PER IT APPLICATION I, hereby authorize E✓l` Name ofC-57 Licensed Authorized Representative Print Name of Authorized Agent 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. LI ID04 —06 04,07,?022 Page 2 ort well / Pump Permit