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DATE: ~ -))- ~ CITY OF ZEPHYRHll.LS - BUll.J)ING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# No constnIctlon under ground or above ground ohny facility shall be accomplished on any City Rights of Way without written approval from the City Building Department. Any application for approval of constniction operations on any City owned Rights of Way shall fumbh a detailed drawing showing the complete scope of the proposed work in trlpUcate to the office of the Building onIclal for approval prior to the commencement of any work. A copy of this permit Is to be kept readily avaUable at the site of the work at all times. PARCELLD.#/;! -;l.~-?-I-0500 -OOOQO-0156h-vROAD Jq3Lj) I' Cj /j()C DATE LOCATION (Legal Description) : ,€uJ4 7/ / I of Permission is hereby granted to for Che construction and maintenance of subject to the following conditions: 1. The constniction and maintenance of such utility shall not interfere wiCh the property and rights of a prior occupant. 2. All work shall be done In keeping with the standards of the City Streets Department and under Che supen-ision of the City Building Offtelal, who wili be notified at least one day prior to commencement of constroction. 3. All materials and equipment shall be subject to inspection by the City BuDding OffteiaL 4. During constniction all safety regulations of the Department of Transportation shall be obsen-ed and the City shall be reUeved of all responsibility from damage of any nature arising from this permit. Subject to the same terms and conditiom, the permit holder may take I1ICh safety measures, including placing and display of caution signs, as it may deem necessary in conduct of constroction and maintenance work hereunder. It is Che responsibility of Che permittee to place, maintain, and supen-ise all traffic controi and device.. 5. All private and all City properly shall be restored to its original condition as far as practical in the opinion of the City Building OffteiaL 6. All 1Dlderground crossing installations .hall be laid at .uch depCh as may be specified by the City Building OfticiaL 7. The sketch covering the details of this installation.hall be made a part of this permit. This permit is granted with the undentanding that Che applicant has notified all other utility usen in the area covered by the permit and takes full re.ponsibility for any damage ineurred by prior installations as a result of his operations in order that they may .afe guard their interests. 8. It is expressly stipulated that this permit is a liceIIIe for permis.Ive use only and that the placing of facilities upon pubUc property punuant to this permit .hall not operate to create or to ve.t any property right in said holder. 9. Whenever the City decides to further eIplolt the City Rights of Way, any or all said pole., wire., pipe., cables, or other facilities and appurtenances authorized hereunder, shall be Immediately removed from said Rights of Way, or reset or relocated Chereon as required by the City BuDding Offtelal at the expense of the holder of this permit. 10. The holder shall .ave and keep the City harmless from any and all damages, claims, or injuries that may occur by reason of the constroction, maintenance, and operation of said facility. 11. The holder shall complete the requested work within days or this permit shall become null and void. In the event the work requested b not completed upon the expiration date of this permit, the City shall have the right to complete such work and to charge the holder of the permit for all costs incurred in completing said work. 12. The hoider shall post a cuh or surety bond with the City Manager in the sum oU doUan to guarantee performance of the obUgations herein, and to guarantee maintenance of the right-of-way described herein for a period of one (I) year following compietion of the requested installation. In the event a .urety bond b posted, the surety bond shall be made payable to the City and shall obUgate the surety to hold the City harmle.s in the event the holder of this permit shouid fall to meet any of its obUgatlons hereunder. The bond shall also indemnify the City for all court COlts and reasonable attorney's fee. in the event legal action is required to collect on said bond. 13. The permittee shall have a 24 hour emergency contact name and number listed below. Address -.> {)~ ~' Slgnature&Title f)~~ t/] t/ -;~5r 7/ J -.2 7 r L Phone APPROVED BY: cm' OF ZEP Public Works Date: fs;, ()-o~ Building onIcial Date: Utilities Supen-isor Date: City Manager Date:.