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DATE: /zh ~ )t>'-f I . CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# No construc&.. wader ground or above ground of any faclWy .ball be accomplilhed on any City Rlghtl of Way without written approval from the City BuIldinl Department. Any applkation for approval of construction operatiom on any City owned Ri&htI of Way aha1l fumlah a detailed drawing ahowlng the complete ICOpe of the propo.ed work In triplicate to the offtce of Che BuIlding 0fIIc1al for approval prior to the commencement of any work. A copy of this permit b to be kept readily available at the .ite of the work at all time.. 1'\ PARCELLD.## I~ 'Zio 2...1 (jo'7U C)7400 e)Ob~ROAD 201'~ "PI. DATE 12/' ';J)~LJ I LOCATIoN (Legal Description) : 1. ~ TA- ST, ~o\.nft- el;oo ",;;r;:; ? p rl~ sr. of J~~ C,O. !'f.A,,~1)1 F)uflfN.J~ Permission b hereby granted to for Che conatructlon and maintelUlllCe of ~"F~f ~. subject to Che following conditions: 1. The construction and maintenance of .ueb utility .ball not Interfere wlCh the property IIIUi rlghtl of a prior occupant. 2, AU work sball be done In keeping wlCh the standard. of Che City Streets Department and wader Che .upervlslon of the City BuIlding Offtclal, who will be notified at least one day prior to commencement of COIIItnaction. 3, AU materia1a and equipment sball be subject to Inspection by the City BuDdinl Oflklal -t. Durinl COIIItruction all safety regulatlona of the Department of Transportation aball be ob.erved and the City .ball be reUeved of all responsibility from damage of any nature arising from this permit. Subject to the aame terma and concUtionI, the permit holder may take .ueh safety mea.aurea, including p!acinl and display 01 caution siglu, u It may deem necellary In conduct of COlUtruction and maintenance work hereunder, It Is the resporulbillty of Che permittee to place, maintain, and aupervlse all traflk cootrol and devices. 5. AU private and aU City properly aha1l be reatored to ItI original concUtion u far u practical In the opinion of the City BuDding otftclal 6. AU waderground cros.1ng hutaUationa aball be laid at sucla depthu may be apeclfted by the City BuDding Official 7. The sketch covering Che detalb of this inItaUatlon .ball be made a part of this permit. ThIs permit Is granted wlCh the undentandlng Chat Che applicant)UP notifted aU other utUity uaen in the area covered by the permit and take. fuU respOlUlbillty for any damage inauTed by prior inItaUatlona u a reault of his operationa In order Chat Chey may .afe guard their Intere.tI. 8, It Is eIpressly atipuiated Chat this permit Is a licetue for permlsalve DIe only and Chat the p!acinl of faclUtiel upon public property punuant to this permit sball not operate to create Or to vest any property right In aaid holder. 9. Whenever Che City decides to t\u1ber uplolt the City Rlghtl of Way, any or all.aid polea, wirea, pipe., cable., or other facilltie. and appurtenance. authorized herewader, aha1l be immediately removed from .aid RIght. of Way, or relet or relocated thereon u required by the City BuDdinl Oflklal at the upenae of the holder of this permit. 10, The bolder .ballaave and keep the City harmle.a from any and aU damagea, claim., or lnJurieI Chat may occur by reuon of the CODItruction, maintenance, and operation of .aid facility. 11. The holder aha1l complete the requested work within daya or this permit .ball become nuB and void. In the event the work req_ted Is ~t completed upon the uplration date of this permit, the City aball have the right to complete .ucla work and to charge the holder of the permit for all co.tI Incurred in completing .aid work. 12. The holder shaD poat a cash or .urety bond wlCh the City Manager In the aum of S dollan to guarantee perfol'lDllllCC of the obliptiona bereln, and to guarantee malntelUUlCC of the right-of-way dClcribed herein for a period of one (1) year following completion of the requested inItaUation. In the event a surety bond Is posted, Che .urety blllld sball be mad~ payable to the City and .ball oblipte the .urety to hold the City harmlell In the event the holder of tbJI permit ahouid fall to meet any of its obliptionl herewader. The bond .ball alIo indemnify the City for all court co.tI and reuonable attorney'a fee. In the event legal action Is required to coUed on .aid bond. 13. The permittee .ball have. 24 hour emergency contact name and number listed below, SUBMlTI'ED BY: (permittee) t/lb:-t-.'bJ. ( CO . Signature & Title C&Lo a ~3{ ':) Address Phone ~oq -Lf-lllC( -II~ I APPROVED BY: CITY OF ZEP Public Work8 Date: BuDding Official Date: Utilitie. Supervisor Date: CIty Manager Date: