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<br />DATE: Ill7lo~ <br />, <br /> <br />CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT <br />RIGHT-QF-WAYUSEPERMIT PERMIT# <br /> <br />l\o'h.Ae& <br />'\h~/OCo <br /> <br />No __IIaD DB"'" p1nUld or above VODBd of...y flldllty IW be ueomplllhed OD IIDy CIty Rlahll of W." wItIaout wrItteIl approval from tile <br />CIty BulIdIaa ~t.1ury lIppJladlcm far opproVlll of eo"-u opentlODlU IIDy CIty o_ed Ripll ofW." sIuill f10naIU a detded drawmC <br />IIaowlq tbe eomplete ICope of Ole ~ work IIllrlpllcate 18 tile omee of tile BulIdIIla 0lIIeIaI for opproftl prior 18 au eo........,........t of..y _rJe. A <br />....y ofCldl permit II to be kept radIIy awllable at tile lite ofth. work at aD limes. <br /> <br />PARCELI.D.' <br /> <br />CITY ROAD <br /> <br />~~ <br /> <br />Av<... <br /> <br />DATE <br /> <br />LOCATION (Lep1 DesertpllaD): (]~ L1 \' <br />tr rr-v (. l.J.. O{~~ <br />2tP4'"(~: (l,S <br /> <br />i!F 6(..A.(( 13l~~ ./4S ~O I <br /> <br /> <br />?~f().I't cfA.- <br />s..; (. <br /> <br />"'- <br />_mbject to tbe foIIowIIli .....dIIIoDl: <br /> <br />1. Tbe efIIIItradIoD ..d maIIlten.... of ouch utility sIuill DOt IIlterf.... with tile property ..d rf&bll of a prfor oe""paDL <br /> <br />1. All _rk..... be .....1Il1roeplaJ with tile _danb oftbe CIty SIreelI ~t ...d UDder tile lapervlllOIl of tile CIty BulIdIIla 0IlIdaI, wloo <br />wOl be..-ed at 1alt01le day prforto .....~_oqt of._ <br /> <br />3. All materbll..d eqvIpmeDt IIoaII be IIIbject to 1IlIpecU0Il by tile CIty BulIdIIl, OftIdaI. <br /> <br />4. DarIJqr...-...uoD all safety "'PIatlODI of doe Departmot of'Tnupo_1l lloaIl be oboerved 0Ild tbe CIty IbaII be rdIned of aD <br />rapollllldllty rr- daJaace of..y 1UIture lIrfIIIlc from CIdI permit. s.bjeet to tile .... -. .... eoDdltlo.... tile permit bolder may llob .... safety <br />-ura,1DcI1ldIIlt pladDJ ad dllplay ofeaDIIon....... a It may deem --.y III eo_ct of eoIIIIruetloD 0Ild __ _ benuder. It II the <br />respollllldllty of tile permittee 18 '1?11 <br /> <br />5. All prfVate..d aD City properly sIoaI1 be resIIlred to ill orialllal.....dfUoll a fllr u practleallll tile opIIl!OD of tile City BulldIIla OftIdal. <br /> <br />6. All aaderp-owad ...-, iDIIlIIhItIa.. ..... be laid at meIo depth .. may be spedlIed by the CIty BulldIIlc 0fIIeIaI. <br /> <br />7. TIle IbteIo eovam, tlte detds oftlds bubIIIatIOD lIoaD be IIUIde a part of lIdI permit. 1'101I permit lI_ted with tile DDdentudlllC tIoat the <br />oppJ/eaat loa DoUfted all other IIIIIIty BIen III tile -- covered by tile permit ad tUa fIdI ........-mty for uy daJuae lIleurred by prfor lIutdadom u a <br />remit of Ida opentIODIIIl order tIIat they m." lafe pard their 1Il_. <br /> <br />a. It II apreuIy ItIpaIated that tIds permit II alkeoue for permIaIv. .... 0DIy ad that tbe (lIadDa offaellltl.. __ publk --"y parnut to <br />lIdI permit lIoallllOt operate to ereaIe or to vat uy property rf&Iot III aid IooIder. <br /> <br />9. WIo_ tile CIty dedda to IUrtber npIoIt th. CIty RiPts ofW.", ..y or all aafd po.... wIra, pipa, eabIu, or other fadlltlea ..d <br />IIpp1D"teJumea authori2lOd IleftDDder. sIoaI1 be immediately removed hm aid R1pts ofW.", or reset or reIoealed 1heno1l a required by tile CIty IIuIIdIIlc <br />0lIIeIaI at doe upeDIe ofth. IooIder of CIdI permit. <br /> <br />10. TIle bolder...aD lave ad keep tile CIty harmI... from IIDy ad all d......... dalma. or lDJurIea that may....... by......D of the COIlItrucUOD, <br />_tmmce, ..d Op....UOD of aafd facfIity, <br />I <br />11. Tbe bolder IW eompIele th. nquested work wItIIIIl daYI Or tIds permit sIuill ~ DuD .... void. .. tbe eveDt doe _rk <br />requeated IIllot eompleted _D th. e:qdrat(OD date oftlds permit, tbe CIty lloaIl bav. the t1pt 18 complete ....,b work ODd to ebup doe bolder of tile permit <br />for aD -1Ilc1ured1ll oompl-. aafd work. <br /> <br />12. The bolder sIuill pOlt a ..... or I1l1'ety boDd wItII the CIty Maaa,...1Il th. lum ofS_ dollan to _tee perfomumee of the <br />obllptlau loenIa,..d to parutee m...._.... of the ...kf...." deoerIbed benm for a period of.... (1) year folJowlllg eompleUo oftbe requested <br />IIlItaIIatIoa. .. the eveat aaurety boad II ~ the aurety boad abaD be made payable to doe CIty..d IW......... tile IIIftty to bold the CIty IoarmJea lD <br />doe cvmt tbe bolder of_ permit daoaId fall to meet..y of ill obilpUODJ baelmder. TIle bolld aIoaII aJso ~ the CIty for .. _... ad <br />......JUlbIe -meys fees to doe eveat 1eplacUoD II required to eoDect OD aald bud. <br /> <br />SUBMI'ITED BY: <br />(PermIltee) '^^-~ k ~-.)",~-,,", I s l.A.>S F;(2!r.T 12t".s(<J~. <br />Slpatona:nlle ~~...e '}>-, O(><4.t.Ti..ll\\ 5", f.cltv,"'.r< <br />Addreu t(b( ...u..~Q\o..<.l~ ~\...\A --r'A~A, f9.. '3~VI:l-S- <br /> <br />APPROVED BY: <br /> <br />PubUc Workl <br />DalE: <br /> <br /> <br />CITY OF ZEPBYRmLLs <br /> <br />CIty MaIl.,er <br />Date: <br />