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DATE: CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# No construction under ground or abon ground of an~' facility shall be accomplished on an" CIty RIghts of Way wIthout written approval from the CIty BuildIng Department. Any application for approval of constructIon operations on any CIty o1'lned RIghts of Way ~hall furnish a detailed drawing showing the complete scope of the proposed work In triplicate to the office of the Building OfficIal for appronl prior to the commencement of any work. A copy of thIs permit 18 to be kept readily available at the sJte of the work at all times. PARCEL r.D. # ()2-:Z lb -21 '"I()05o~ooooo-. OOliTY ROAD Ai {J4111,' A v/~ _ DATE LOCATION (Legal Description): Permission I~ hereby granted to for the construction and maIntenance of of ~ubJect to the followIng conditIons: I. The construction and maIntenance of such utility shall not Interfere with the property and rights of a prlol' occupant. 2. All work shall be done In keeping wIth the dandards of the CIty Streets Department and under the supenldon of the CIty Building Official, who will be notified at least one da,' prior to commencement of constructIon. 3. All materIals and equipment shall be subject to Inspection by the City BuildIng Official. 4. During con~tructlon all safety regulatlon~ of the Department of Transportation shall be obseM'ed and the CIty shall be relined of all responsIbility from damage of any nature arIsing from thIs permit. Subject to the same terms and condltlon~, the permit holder may take ~uch safety measure~, including placing and dIsplay of caution slgn~, as It may deem necessary In conduct of construction and maintenance work hereunder. It Is the responsIbility of the permIttee to place, maintain, and supeM'lse all traffic control and devIces. 5. All prIvate and all CIty properly shall be redored to Its orIginal condItion as far as practical In the opInIon of the CIty BuildIng OfficIal. 6. All undergl'Ound crossIng installations shall be laId at such depth as may be specified by the CIty Building Official. 7. The sketch coverIng the details of thIs Installation shall be made a part of this permit. This permit Is granted with the underdandlng that the applicant has notified all other utility users In the area covered by the permit and takes full responsibility for any damage Incurred b~' prior Indallatlons as a result of his operatlon~ In order that they may safe guard their Intereds. 8. It Is expressly dlpulated that this permit Is a license for permlsdve u~e only and that the placing of facilities upon public property punuant to this permit shall not operate to create or to vest any property right In said holder. 9. Whenever the City decides to further exploit the City ~Ights 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 re~et or relocated thereon a~ required b~' the City Building Official at the expense of the holder of thIs permit. 10. The holder shall san and keel' the City harmless from any and all damages, clalm~, or InjurIes that may occur by reason of the condructlon. maIntenance, and operation of "aid facility. ll. The holder shall complete the requested work within days or this permit shall become null and voId. In the ennt the work requested I~ not completed upon the expiratIon date of this permit, the City shall han the rIght to complete such work and to cha'1le the holder of the permit for all costs Incurred In completing said work. 12. The holder shall post a cash or surety bond with the City Manager In the sum of $ dollars to guarantee performance of the obligations hereIn, and to guarantee maintenance of the rlght-of.1'I'ay described herein for a period of one (1) year following completion of the requested IndaUatlon. In the event a sure~' bond Is poded, 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 pennlt should fall to meet any of Its obligations hereunder. The bond shall also indemnIfy the CI~' for all court costs and reasonable attomey'~ fees In the event legal action Is required to collect on said bond. 13. Thc permittee shall hal'e a 24 hour emergenc,' contact name and number listed below. (PermIttee) --fJ. SUBMITTED BY: l~jkth~AA 0-- SIgnature & Title Address Phone APPROYED BY: CITYOFzEP~ ~ ::::~... om".. ~ ~ _ 'S "" Utilities $upeM'lsor ~ ~ n.m, ~ ~:~~:c Works ~ ~:'J.~"'q~<;M' iJ' ^-