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DATE: /tl- c:2 7- 0 $/ , CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# 3rJ/? No coostruction under ground or above ground of any facility IbaII be aceomplUhed on any City RIghts of Way without written approval from die City Building Department Any applkation for approval of consh1lction operations on any City owned Rlghtl of Way IbaII fumUh a detaIled drawing showing the complete scope of the propoled work In triplicate to the ofllee of the Building Oft'klal for approval prior to the commencement of any work. A copy of thil permit il to be kept readily available at the life of the work at all times. PARCEL LD. ## CITY ROAD 13~ /?Ve. DATE / ~ /~7IfJt/ I LOCATION (Legal DeICription) : Permisllon is hereby granted to for the constnaction and maintenance of of ~J.-} V1i:...w ;4'f ~ lubject to the following conditions: 1. The construction and malnfenance of IUch utility IbaII not Interfere with the property and rightl of a prior occupant 2. AU work IbaII be done In keeping with the ltandardl of the City Streetl Department and under the IUpervision of the City Building Offtcial, who wili be notified at least one day prior to commencement of coostruction. 3. AU materlals and equipment IbaII be lubject to Inspection by the City BuDding Oft'k1aL 4. During consh1lction alllafety regulations of the Department of Transportation IbaII be obllerved and the City lball be reUeved of aU responsibility from damage of any nature arising from this permit Subject to the lame terml and conditions, the permit holder may take luch Ialety measurel, Including placing and display of caution ligm, lU It may deem neceslary In conduct of construction and maintenance work hereunder. It is the responsibility of die permittee to place, maintain, and lupervise aU traffic control and devicel. 5. All private and all City properly IbaII be reltored to its original conditionlU far lU pnetic:alln the opinion of the City Building Oft'k1aL 6. AU underground Crolling Installatlom IbaII be laid at luch depth lU may be lpecifled by the City Building OfticIaL 7. The lketch covering the details of this Installation IbaII be made a part of this permit TbiI permit is granted with the undentandlng that the applicant has notifted aU other utility usen In the area covered by the permit and takel full relponslbility for any damage lneurred by prior Installations lU a result of his operations in order that they may .ale guard their intereltl. 8. It is exprellly .tipulated that this permit is a llceme for permisllve UIIe only and that the placing of facilide. upon pubUc property punuant to this permit IbaII not operate to create or to velt any property right In laid holder. 9. Whenever the City decidel to further exploit the City RIght. of Way, any or all.ald pole., wire., pipe., cableJ, or other facilitie. and appurtenancel authorized hereunder, IbaII be immediately removed from .ald RIghts of Way, or relet or reiocated thereon lU required by the City Building Oft'klal at the expeme of the holder of tbiJ permit 10. The holder .baII.ave and keep the City harmlell from any and aU damageJ, Clalml, or lnJurie. that may occur by relUon of the CODItruction, maintenance, and operation of laid facility, 11. The holder IbaII complete the requelted work within day. or this permit lball become null and void. In the event the work requelted is not completed upon the expiration date of tbiJ permit, the City IbaII have the right to complete luch work and to charge the holder of the permit for aU co.ts Incurred in completing .ald work. 12. The holder .ball polt a ClUh or lurety bond with the City Manager In the IWD ofs dolIan to guarantee perfOI'lllllDCe of the obllgatioDl herein, and to guarantee maintenance of the right-of-way described herein for a period of one (1) year following completion of the requelted IDJtaUation. In the event a lurety bond is pOlted, the lurety bond .ball be made payable to the City and .ba11 obligate the .urety to hold the City harmlellln the event the holder of this permit mould fall to meet any of its obligations hereunder. The bond .ball abo indemnify die City for aU court co.ts and reasonable attomey'. fee. In the event legal action is required to colleet on laid bond. 13. The permittee IbaII have a 24 hour emergency contact name and number Jilted below. SUBMITrED BY: (permittee)//' ~h V 0~ Signature & Title C5/- p, C C rf...-G Ie.. a _ L _ $. Tt:::YC (! 0 0 '!; 7 Addrell 37,,~/ fm Ai ~~J-/'iR..t:J((.c.J.. rL ~3&lfL C r/~) 7ed- J1lLVd Phone APPROVED BY: :::~~~ Date:_ ~w:- ~~i~ :p/ fl. ~t~) ;vw- ~-r) City Manager Date: