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<br />DATE: '-( /~ I O~ <br /> <br />CllY OF ZEPHYRHILLS - BUILDING DEPARTMENT <br />RIGHT-OF-WAY USE PERMIT <br /> <br />PERMIT# <br /> <br />No construction under ground or above ground o( an". (aclllf)" shall be accomplished on any Clly RIghts o( Wa". without written approval from the <br />Clf)" Building Department. Any appllc:atlon for approval o( construction operations on any Clf)" owned Rights of Way shall fUrnish a detailed dnwlnl show.... <br />the complete scope of the proposed work In triplicate to the olflee o( the Bulldln. Official for approval prior to the commencement of any work. A cepy of thIa <br />permit Is to be kept readily available at the site o( the work at all times. <br /> <br />PARCELI.D.N l~-2(".. 21- 0170 -OOOQO - 0230 <br /> <br />CITY ROAD <br /> <br />Y5"jl <br /> <br />I? as (Q <br /> <br />;?""" c 1.. 01", <br /> <br />DATE '-/&1 ()(;, <br /> <br />LOCATION (Legal Description): <br /> <br />r.,~ I. ~. cL. $1<1,,); V, ~ ; 0" <br />p~ ~ Pc. (l<.( <br />f- 23 <br />Of2 '" 2.YO j)~ o"1~\ <br /> <br />Permission Is hereby granted to ell,... "8. f~" $..\., T,,::, c. . of 2~f..v r ~.l k I <br />for the construction and maintenance' o( .J . ~ .:. c:.( ..f... r S ;''3 \ ~ hi,... 'y Dwe1Ll.1s <br /> <br />subject to the (ollowlng conditions: <br /> <br />Pc. <br /> <br />1. The construction and maintenance o( such utlllf)" shall not Interfere with the property and rlghtl of a prior oceupant. <br /> <br />2. All work sh~1I be done In keeping wllh the 8Candards o( the City Streets Departlbent and under the lupervlslon o( the City BuDdin. OfIIcIaI, who <br />will be notlDed at least one day prior to commencement o( construction. <br /> <br />3. All materials and equipment shall be subject to inspection by the Clf)" Building OfficiaL <br /> <br />4. During construction all safety regulations o( the Department of Transportation shall be observed and the City lhaII be relieved of aD <br />responslblUty from damage of any nature arising from this permit. Subject to the same terms and condlllons, the permit holder may take such ..fety meuure., <br />including placing and display of caution signs, al It may deem necessary In conduct o( construdlon and maintenance work hereunder. It II the I'elpotIIlblUty of <br />the permlltee to place, maintain, and supervise all traflk control and devices. <br /> <br />S. All private and all City properly shall be restored to lis original condition as far as pnctlcalln the opinion of the City Bulldlnl Oflklal. <br /> <br />6. All underground crossing installations shall be laid at such depth as may be speclOed by the City Building OflklaL <br /> <br />7. . The sketch covering the details o( this installation shall be made a part o( this permit. This permit II granted wllh the undentandlnl that the <br />applicant has notlned all other utility users In the area covered by the permll and takes fUll responllblllty (or any dama. lneurred by prior InstaDatlou AI . <br />resull o( his opentlons In order that they may safe guard their Interests. <br /> <br />8. It Is ellpressly stipulated that this permit Is a license (or permissive use only and that the placing o( facllltlew upon public property punuant to this <br />permit shall not operate to create or to vest any property right In said holder. <br /> <br />9. Whenever the City decides to further ellploll thc City Rights o( Way, any or all said poles, wires, pipes, cables, or ether faclDtlel lIIlCI <br />appurtenances authorized hereunder, shall be Immediately removed from said Rights of Way, or reset or relocated thereon AI required by the CItY BuIld.... <br />Oflklal at the expense of the holder o( this permit. <br /> <br />10. The holder shall save and keep the Clly harmless (rom any and all damages, claims, or injuries that may occur by reuon of the COIIItruetlon, <br />maintenance, and operation o( said (aclllty. <br /> <br />II. The holder shall complete the requested work within days or this permit shall become nuD and void. In the evmt the work requelted <br />Is not completed upon the nplratlon date of this permit, the City shall have the right to complete such work and to chal'le the holder of the permit for aII_C. <br />Incurred In completing said work. <br /> <br />12. The holder shall post a cash or surety bond "lIh the City Manager In the sum ofS doUan to guarantee perfomuuac:e of the obllptlou <br />herein, and to guarantee maintenance o( the right-of-way described herein for a period of one (I) year followlol cempletlon of the requested installation. In the <br />event a surety bond Is posted, the surety bond shall be made payable to the City and shall obligate the surety to hold the Clf)" harmlesl In the evmt the holder of <br />this permit should fall to meet any of Its obligations hereunder. The bond shaD alsolndemnll) the City for all court cost. and re......ble attomey'l feel In the <br />evmt legal action Is required to collect on said bond. <br /> <br />13. The permittee shall have a 24 hour emergency contRct name and number listed below. <br /> <br />SUBMITTED BY: <br />(permittee) t-\c..rf)() 'To"" Oc,,' (bee <br />Signature & Title I)JU tic t:>p,;t; <br />~ ,/ <br />Address 3(., I..{I~ 5 +c.+e ed. SL( <br />Phone (&13) 7 g Z - D g 2. (- <br /> <br />5) o.!o{ <br /> <br />./ <br /> <br />~ <br />ra5P <br /> <br />/?J!; "-- <br /> <br />f~l, / gb <br />! ( <br /> <br />, ~' <br />lJV ) <br />y ~~ t <br />('17~ cfi /;~ <br />~{f ~tvv <br /> <br />Ii <br /> <br />City Manager '& <br />Date: <br />, <br />