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DATE: / J-z.. ~JD{c I CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# 5';;2 V 5' No construction under ground or above ground of any raclllty shan be accomplished on any City RIghts of Way without written approval from the City BuDding Department. Any application for approval of construction operations on any City owned Rl&ht. of Way IhaII fumlsh a detailed draw"'lhowfnJ the complete scope of the proposed work In triplicate to the office of the BuDding OffIcial for approval prior to the commencement of any work. A copy of this permit II to be kept readny avanable at the lite of the work at an times. fe, 'Z..l - D PARCELI.D.N 1'2...- ~ -z.... - 100 -Ot:X'oo-o33ceITYROAD () L D MILl L PI, DATE j- ~ 'y-O?> LOCATION (Legal Description): Permllllon il hereby granted to ~ \ C) If 10 ~ r L <?O 1-'0 l<- Co c9 cF<i' of for the construction and maintelllUlCe of '::i) R-. / V e1.,.(...) it' 'r' lubject to the following conditionl: 1. The construction and malntelllUlCe of luch utility lhan not Interfere with the property and right. of a prior occupant. 2. All work Ihall be done In keeping with the ltandardl of the City Streets Department and under the lupervilllon of the City Build'" OffIcial, who wDI be notified at least one day prior to commencement of conltruction. 3. All materiall and equipment lhan be subject to inspection by the City BuDding Official 4. During construction alllafety regulationl of the Department of Transportation IhaD be oblerved and the City IhaII be relieved of all relponllblllty from damage of any nature arillng from this permit. Subject to the same terml and conditionl, the permit holder may take luch safety measures, including plac'" and dillplay of caution Signl, al it may deem necessary in conduct of constnlctlon and maintenance work hereunder. It is the responsibility of the permittee to place, maintain, and supervise all traffic control and devices. 5. AD private and all City properly shall be restored to its original condition al far as practical in the opinion of the City BuUding OffIcial 6. All underground crolllng installations lhall be laid at luch depth as may be lpecified by the City Building OffIcial 7. . The lketch covering the details of this inltallation Ihall be made a part of thll permit. Thll permit is granted with the undentanding that the applicant has notified all other utility ulen in the area covered by the permit and takel fuD relponlibility for any damage ineurred by prior Installations as a relult of his operatlonl in order that they may lafe guard their interelts. 8. It is exprellly stipulated that this permit Is a license for permllslve use only and that the placing of facilities upon pubDc 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 Rights of Way, any or allsalel polel, wires, plpel, cables, or other facilities and appurtenanees authorized hereunder, shaD be Immediately removed from laid Rlghtl of Way, or reset or relocated thereon as required by the CitY Build'" Official at the expenle of the holder of this permit. 10. The holder lhalllave and keep the City harmless from any and all damagel, claim I, or InjUrlel that may occur by reason of the _tructlon, maintenance, and operation of laid facility. 11. The holder IhaD complete the requested work within ? days or thll permit IhaII become nuD and void. In the event the work requested II not completed upon the expiratlen date of this permit, the City lhall ha've the right to complete II1Idt work and to charge the holder of the permit for all COlts incurred in completing laid work. 12. The holder IhaD post a cash or surety bond with the City MlIIIIlger In the lum of S dollan to guarantee performanc:e of the obligations herein, and to guarantee maintenance of the right-of-way delcribed herein for a period of one (1) year following completion of the requelted installation. In the event a surety bond il pOlted, the lurety bond lhan be made payable to the City and IhaD obDgate the IUrety to hold the City harmletl in the event the holder of this permit should fail to meet any of It I obligations hereunder. The bond shaD also indemnify the City for an court COItl and reasonable attorneY'1 fees in the event legal action II required to collect on said bond. 13. The permittee shall have a 24 hour emergency contact name and number listed below. (permittee) SUBMITTED BY: ~ 0 i1 (oJ (0 C) Cr7Y o L(.J I..) E IL. Signature & Title Address 3'q I 3 '"S 0 c... D IV1 (c... (. L- tl I Phone 8?"/ 5 - ') ~ f - s S- / V APPROVED BY: CITY OF ZEPHYRHILLS BuDding Official Date: UtUitlel Supervisor Date: ~__ _ ~~Wj~N~~ City Manager Date: