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<br />SITE ADDRESS: 5055 French Camp Rd, Manteca, CA 95336 PERMIT #: I N(1l�' 7
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<br />31S Coordinate: Latitude:
<br />I, the Owner/Applicant/Licensed Well DrillerlPump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmiess
<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 liabilities arising
<br />out of related to or in connection with the application and ap^lied for well ^r pump or to attack, set aside, void, or annul, in whote or in
<br />part approval or den al of the appl ad for permit by the Cou It and arty env r mental review documerds related to the applied for
<br />Perm"
<br />b. For any and al costs and expenses incurred by the County on account of any Claim, except where such indemnification is prohibited
<br />by law, includfng 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 genera Ifees 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 neglbence 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 United to, the manner in which the defense is conducted.
<br />If County reasonably determines that having common courtisel presents such couMel 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS
<br />CURRENT AN ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br />WORKERS PENSATION L
<br />E
<br />ERTY ER:
<br />PRINT: Pie&dtC DATE
<br />WELL DRILL U11P .TRACTOR:
<br />ager A°ea°.,', "Tony" 31212022
<br />µ°�R°°°°'^�°° °4s°� _ PRINIRobert Tony Martin, (PG C-57 RMEb
<br />SIGN: s°am.°monk ATE
<br />.1.�,°
<br />AUTHORIZATIOWFOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />[, hereby authorize
<br />Nz—orC-S` LK—d Amhw—d Rcp—wmi- Pim Nam: of Amh—d Ag.M
<br />to sign this San Joaquin County Well & Boring Permit Application on my behalf. I 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 />E11D644 oA io 25 2021 P,du , ,r? um Pump Pcrma
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