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sF �� Citylof ZephyrhillS PERM IT'N_UMBER`"
5335 Eighth Street
Zephyrhills, FL 33542 BGC-000660-2020
Phone: (813)780-0020
� .Issue Date: 09/01/2020
Fax: (813)780-0021
Permit Type: Building General (Commercial)
Property Number Street Address'
14 26 21 0000 04700 0010 South Ave Btween 7Th St Gall Blvd
Owner Information Permit Information Contractor Information
Name: Permit Type:Building General(Commercial) Contractor: CITY OF ZEPHYRHILLS
Class of Work:Right of Way Temporary Use
Address: Building Valuation:
Electrical Valuation:
Phone: Mechanical Valuation:
Plumbing Valuation:
Total Valuation:',$0.00
Total Fees: /
Amount Paid:
Date Paid:
Project Description
SOUTH AVE BTWEEN 7TH ST AND GALL BLVD-FEE WAIVED
Application Fees
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications add fee Must Accompany Application.All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
j
CONTRACTOR SIGNATURE PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
I
CITY OF ZE ILLG-BU|LDING DEPARTMENT
RIGHT-OF-WAY USE PERMIT
DATE: PERMIT#:
No construction under ground or above ground of any facility shall be accomplished on any City Rights of Way without written approval from the City Building
Department. Any application for approval of construction operations on any City owned Rights of Way shall furnish a detailed drawing showing the complete
scope of the proposed work in triplicate to the office of the Building Official for approval prior to the commencement of any work. A copy of this permit is to be
kept readily available at the site of the work at all times.
PARCEL|O CITY ROAD South Ave between 701 Street and Gall Blvd.
LOCATION(Legal Description):
THE NORTH 1/2 OF THE FOLL DESC A STRIP OF LAND 100.00 FT IN WIDTH 50.00 FT ON EACH SIDE OF THE CENTERLINE OF
SEABOARD COAST LINE RR FORMER MAIN TRACK SAID STRIP EXTENDING BETWEEN THE SOUTH LINE OF SOUTH AVE &THE
NORTH LINE OF AVE A EXC POR DESC AS COM AT SE COR OF BLOCK 8 OF MOORES FIRST ADD TO ZEPHYRHILLS PB 1 PG 57 TH,
Permission is hereby granted to John Bostic, Utilities Director of the City of Zephyrhills
For the construction and maintenance of*
Monitoring well for environmental sampling. Soil boring will be Performed by hand auger to 5 ft below ground surface. A flush
mount monitor well will be installed to a depth of approximately 100 ft for water quality sampling and monitoring.
Subject ho the following conditions:
1. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant.
u. All workshall b done in keeping with the standards of the City Streets Department and under the supervision of the City Building Official,who
will be notfied at least one day prior to commencement of construction.
u. All materials and equipment shalluo subject ouinspection
4. During construction n safety regulations of the Department mTransportation o»an be u d and the City shall be relieved of all responsibility
from damage of any nature arising from this permit, Subject to the same terms and conditions,the permit holder may take such safety measures,
including placing and display of caution signs,as it may deem necessary in conduct of construction and maintenance work hereunder. It is the
responsibility-the'--_- to
o All private and all City property shall be restored to its originaluonditin far as practical in the opinion of the City Building Official.
- All-underground crossing installations shall_laid-.such_depth as may be specified by the -~ Building_ Official.
7. The sketch covering the details nf this installation shall be made opart of this permit. This permit is granted with the understanding that the
applicant has notified utility area covered by the permit and takes full responsibility for any damage incurred by prio
installations as a result of his operations in order that they may safe guard their interests.
8. It Is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to thispermit shall not operate to create or to vest any `
City ��property
8. Whenever City Rights of Way, any or all said poles, wires, pipes, cables, or other facilities and
appurtenances authorized hereunder, shall be immediately removed from said Rights of Way, or reset or relocated thereon as required by the
City
u The �e Building
Official at the expense of the holder of this permit.
1 and keep the City harmless from any and alld i injuries that may occur by reason o,the construction,
['
maintenance,and operation m said facility. .
11. The holder shall complete the requested work within 20_days or this permit shall become null and void. |n the event the work requested isnot
completed upon the expirationuateofthispunnx.#mCityehm|hove.mahgh|uoonmpomouohworkand\ouhurge0`oUoNo o[the permit for all
costs incurred in completed said work.
12. The holder shall post a cash or surety bond with City Manager in theof of the
obligations herein,and to guarantee maintenance of the right-of-way described herein for a period of one(1)year following completion of the i
requested installation. In the event a surety bond is posted,the surety bond shall be made payable to the City and shall obligate the surety to
hold the City harmless in the event the holder of this permit should fall to meet any of its obligations hereunder. The bond shall also indemnify
the City for all court costs and reasonable attorneys fees in the event legal action is required to collect on said bond.
SUBMITTED BY:
(pERNITTEB
Signature&Title
|
Address 5335 8th Street, Zeph
whills, FL 33542i
APPROVED BY: /
i
CITY oposp*Ym*|LLm '
Utilities Supervisor Date
^CONTR�CTORTOPROV|DE�OT
Public Works o�o ' . `
|TECLEANUP. REGTDRETD
Building Dept ` "== PRECONSTRUCTION CONDITIONS.
City Ma om�
MONITOR WELL CONSTRUCTION
Surface Completion: Stick-up: Manhole:
Slab/Ground Surface.
Type J Grout: Cement
§ Type of Seal: Fine Sand
— Temporary Screen
Type: PVC
Diameter 2
Length: 2'
/ Slot size: 0.010"
Filter Pa
§ Maria: 2 e06|ca sand
$\%
Bottom obre le § Well Depthaprox97
Hdeda 6 m8-inch
NOT TO SCALE
JonesEdmundl
Page 1
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Figure 1
Right-of-Way Boring M-10D2 Location
City of Zephyrhills PFOA/PFAS Investigation
Z
N�
c
SOUTH AVENUE
SS-3 GW=10D2
Parcel: 1-4-26-21-0000-04700-001.0
THE NORTH 1/2 OF THE FOLL DESC
Legend
{} Proposed Groundwater Sample
Proposed-Soil Boring, No Sample
Area of Work
Pasco Parcel M19).. .
0 '25 50 N '
et JonesEdmunds�feet
1:600
FgrInformational Purposes Only Y:\28110-City of Zephyrhills\Projects\034-01-PFOA-PFAS-Assessment\GIS\rtard\GW-10D2 ROW Permit.mxd mhays 8125Y1020
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