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DATE: ~ -)..)- ~ CI1Y OF ZEPHYRHILLS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# No construction WIder ground or above groWld of any facility shaD be accomplished on any City Rigbh of Way without written approval from the City BuDding Department. Any application for approval of construction operatiom on any City owned Righh of Way shaD fumlsh a detalled drawing showing the complete scope of the proposed work in triplicate to the oftlce of the Building Official for approval prior to the commencement of any work. A copy of this permit b to be kept readDy avallable at the site of the work at aU timCl. PARCELLD.# /.;1 -:J-iL> -?-I- 0)00- 0 0 00 D ~015tbvROAD jq 3Lj}.. I' 9 !)tJc DATE LOCATION (Legal Description) : J€uJj 7//1 of Permiulon b hereby granted to for the comtruction and maintenance of subject to the foUowlng conditions: 1. The comtruction and maintenance of such utUity shaU not interfere with the property and righh of a prior occupant. 2. AU work shaD be done in keeping with the standards of the City Streets Department and WIder the supen-blon of the City Building Official, who wili be notified at least one day prior to commencement of comtruction. 3. AU materials and equipment shaU be subject to inspection by the City Building OflIclaL 4. During construction aD safety regulations of the Department of Transportation shaD be obsen-ed and the City shaD be reUeved of aU respopsibility from damage of any nature arising from this permit. Subject to the same terms and conditions, the permit holder may take such safety meaures, including placing and dbplay of caution slgDJ, u it may deem necessary In conduct of construction and maintenance work hereunder. It b the responsibility of the permittee to place, maintain, and supervise aD traffic control and devices. 5. AU private and aD City properly shaD be restored to Its original condition a far a practical in the opinion of the City Building 0ftlc1aL 6. AU WldergroWld crouing installations shaD be laid at such depth a may be specified by the City Building OfttclaL 7. The sketch covering the details of this installation sbaD be made a part of this permit. This permit b granted with the Wldentanding that the appUcant bas notified aU other utUity users in the area covered by the permit and takes full respomlbillty for any damage Burred by prior installations as a result of biB operations in order that they may safe guard their interesh. 8. It b exp.-essly stipulated that this permit b a license for permbslve use only and that the placing of facilities upon pubUc property punuant to this permit shaD not operate to create or to vest any property right in said bolder. 9. Whenever the City decides to further exploit the City Righh of Way, any or aD said poles, wires, pipes, cables, or other facilities and appurtenances authorized hereWlder, shaD be immediately removed from sald Righh of Way, or reset or relocated thereon a required by the City Building Official at the expense of the bolder of this permit. 10. Tbe holder shaD save and keep the City harmless from any and aU damages, claims, or Injuries that may occur by reaon of the constl1lction, maiDte_e, and operation of said facility. 11. The holder sbaU complete the requested work within days or this permit shaD become null and void. In the event the work requested b not completed upon the expiration date of this permit, the City shaU have the right to complete such work and to charge the bolder of the permit for aD cosh Incurred in completing said work. 12. The bolder shaU post a cuh or surety bond with the City Manager In'the sum of S dollars to guarantee performance of the obUgatiom herein, and to guarantee maintenance of the right-of-way described herein for a period of one (1) year following completion of the .-equested installation. In the event a surety bond b posted, the surety bond shaD be made payable to the City and shaD obUgate the surety to hold the City harmless in the event the holder of this permit shouid faD to meet any of its obUgatiom herellDder. The bond shaD also indemnify the City for aU court cosh and reaonable attorney's fees In the event legal action Is required to collect on said bond. 13. The permittee shaD bave a 24 hour emergency contact name and number listed below. Address ~/~' (permittee) AJ..f...- Signature & Title 1) A-ffc tll t.( -;"5r 7/ J - J- 7 7 L Phone .., UtUiCies Supervisor Date: Public Works Date:, L- o -() c.o ~ City Manager Date:: ~~