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DATE:-2J ( 5 J 67 CITY OF ZEPHYRlIULS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# 'IJ '5'~ ~ 3&;}.3 - 3 FFAtJAb ' , No cOlIStruction under ground or above ground of any facility shall be QCcomplished on any City Rights of Way witbout writte~ approv~ from th~ City Building Department. Any' applicalion for approval of cOlIStruction operatiollS on any City owned Rights of Way shall furnisb a detailed drawmg 5b.ow~g the complete scope of the proposed work in triplicate to the office of the Building Official for approval prior to tbe commencement of any work. A copy of this permit is to be l!:ept readily available at the site of the work at all times. PARCEL LD. # CITY ROAD DATE LOCATION (Legal Descrlption) : '5+ :51-. 5-fh -5 ' !tine:! 6-e'/' ~ subject to the following conditions: I. The construction and maintenance of such utility shall not interfere with the property and rights of a prior occupant. 2. All work shall be done in keeping with the standards of the Clty Streets Department and under the suporvision of the City Building Official, who will be notified at least one day prior to commencement of construCtiOIL 3. All materiah and equipment shall be subject to inspection by the City Building Official 4. During construction all saCety regulations of the Department oC Tranaportation shall be observed and the City sball be relieved of aU responsibility from damage oC any nature arising from tb.is permit. Subject to tlte same terms and conditions, the permit holder may take such safety measures, including placing and display oC caution signs, III it may deem necessary in conduct of construction and maintenance work bereunder. It is the respolllibility of tbe permittee to place, maintAin, and supervise all traffic control and, devices. 5. All private and aU City propel'ly shall be restored to its original condition as far IU practical in tlte opinion oC the City Building Official. 6. All underground crossing instalIatiolll shall be laid at such depth as may be specified by the City Building Official 7. The sketch covering tlte details of this installation shall be made a part of tb.is permit. Tb.is permit is gr.mled with tlte understanding that the applicant has notified all other utility users in the area covered by tlte permit and takes full respolllibility for any damage irn:urred by prior installatiolll as a result of his operatiolll in order that they may safe guard their interests. 8. It is expressly stipulated that tb.is permit is a license for permissive use only and that the placIng of facilities upon public property pursuant to tb.is 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 oCWay, any or allsald poles, wires, pipes, cables, or other facilities and appurtenances authorized hereunder, shall be immediately removed from said Rights of Way, or reset or relocated thereon III required by the City Building Official at the expense of the holder of tllis permit. 10. The holder shali save and keep the City harmless from any and all damages, claims, or injuries that lWIy occur by rellllon of the construction, maintenance, and operation of said facility. 11. The holder shall complete th~ requested work within daJ's or tIlls permit shall become null and wid. In the event the work requested is not completed upon the expiration date of tb.is 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. Tbe holder shall post a casb or surety bond with the City Manager in'the sum of $ dollars to guarantee performance of the obligatiolll herein, and to guarantee maintenanee of the right-of-way described herein for a period of one (1) year following completion of the requested installation. In the event a surety bond is posted, the surety bond shall be made payable to the City and shall obligate the surety to hold the City harmleSl in the event the bolder of tllls permit should fall to meet any of its obligations hereunder. The bond shali also indemnify tlte City for all court costs and reasonable attoruey's fees in: the event legal action is required to coliect on said bond. 13. The llel'lwttee sball have a 24 hour emergeney eontaet name and munber listed below. SUBMITTED BY: (permittee) V~~K!:rDLLt-G ......... &T'~ I )~ ~ _1 1'/0] NE'.J- P -<;"",.;hJcd- ~/"M T7T P Address &&tX:JAd4YYlt!) 0)./. F'LTP~/.#6;;; -r;,#jPLt PI.. ~5u11 Phone &I~- 7'1t3-/.)s / APPROVED BY: OTIOFuP~ Building Official ... . Date: Utilities Supervisor o.;.-~ Date: Publie Works Date: Clty Manager Date: - .