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DoouSign Envelope ID:2F5211F4-C46F-4908-AE62-521DBBDED73F SITE ADDRESS: 450 East Yosemite Ave, Manteca, CA 95337 PERMIT#: Plot Plan: GIS Coordinate: Latitude: Longitude: 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,exceDt ration is prohibited by law, including but not limited to damages, costs, expenses, attorney's fePq asserted by any person or entity, private attorney general fees claimed by or awarded to a y's costs incurred in preparing an administrative record which are not paid by the petitioner. 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 lieve me 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 only to control the litigation and make litigation decisions,including,but not limited to,the ma If County reasonably determines that having common counsel presents such counsel with a conflic the defense of any Claim or to promptly employ counsel reasonably satisfactory to the County, then County rr, _. oie County Counsel or employ separate outside counsel to represent or defend the County,and I shall pay the reasonable attorney _....0 costs of such 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 1.1('ENSED WELL DRI LLh:R/PUMP C ON'1'RAC'( :DocuSi ned by: � Amanda Hancock 8/11/2022 SIGN: PRINT: DATE AU;ZRIZATION FOR OTHER THAN C-57 SIGNING PERMIT APP 1CATION hereby authorize ✓��41- AL2! 2<�114as Name of C-57 Licensed Authonzed Representative Prim 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. EHD043-06 04/07/2022 Pace 2 of 2 Well/Pu np Pernut