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DoouSign Envelope ID:2F52l lF4-C4BF-4908-AE62-521DBBDED73F }
<br /> SITE ADDRESS: 450 East Yosemite Ave, Manteca, CA 95337 PERMIT#:
<br /> Plot Plan:
<br /> GIS Coordinate:Latitude: Longitude:
<br /> I,the Owner/Applicant/Licensed Well Driller/Pump Contractor agrees to indemnify,defend with counsel reasonably approved by County,and hold harmless
<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 Wth the application and applied for well or pump or to attack,set 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,exceot ration is prohibited
<br /> by law, including but not limited to damages,costs,expenses,attorney's feeq a asserted by any
<br /> person or entity, private attorney general fees claimed by or awarded to a, y'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 participate or direct the defense of any Claim.The County's lieve 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 o1 ority to control
<br /> the litigation and make litigation decisions,including,but not limited to,the ma,
<br /> If County reasonably determines that having common counsel presents such counsel with a conflic the defense of
<br /> any Claim or to promptly employ counsel reasonably satisfactory to the County, then County IT, _. we County Counsel or employ
<br /> separate outside counsel to represent or defend the County,and I shall pay the reasonable attorney _-u 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 AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br /> WORKERS COMPENSATION LAWS.
<br /> PROPERTY OWNER(SIGNATURE IS REQUIRED FOR WATER EXTRACTION WELL ON PRIVATE PROPERTY):
<br /> SIGN: PRINT: DATE
<br /> l.l('E]$F:D�1'F:LI.DRILLER/Pl.'\IP(Y)\'fHA("
<br /> DocuSi neG Dy:
<br /> \ Amanda HdnCOCk $/11/2022
<br /> SIGN: PRINT: DATE
<br /> AURIZATION FOR OTHER THAN C-57 SIGNING PERMIT APP (CATION
<br /> I, hereby authorize 11/1—All —AI'-LZ QAr.,u_ cs
<br /> N.un—rc.s7 l.-.d XwI,. ,d Rgn4,i.,t o Rum N-.ur A.t1 rad.a,�
<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 /> 1.1IIN113-1x,141172022 1'-2or2 'Ad I'unp I'emm
<br />
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