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CITY OF ZEPHYRHILLS — BUILDING DEPARTMENT I/ RIGHT -OF -WAY USE PERMIT • DATE: ;< (`l C) f PERMIT #: n No construction under ground or above ground of any facility shall be accomplished on any City Rights of Way without written approval from the Clty Building Department. Any application for approval of construction operations on any City owned Rights of Way shall furnish a detailed drawing showing the complete scope of the proposed work In triplicate to the office of the Building Official for approval prior to the commencement of any work. A copy of this permit is to be kept readily available at the site of the work at all times. PARCEL ID #: CITY ROAD 5C& i3eL.o� LOCATION (Legal Description): �W Lc / /)/ e 1 L r - p!) 'CPee G Permission is hereby granted to VG /mil ZDti' / 17P of F'LU R i f) f L C. For the construction and maintenance of: r„G /9 /i/h" f t- 7 12,1 /, ? i? " / - 1/)P/ . 131/ 17JR.6 C 0,0 AC_. 13ra /?e / 7`xleN( /f r (J // T / / r //c};' / - ) 1) ) Subject to the following conditions: 1. 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 City Streets Department and under the supervision of the City Building Official, who will be notified at least ono day prior to commencement of construction. 3. All materials and equipment shall be subject to inspection by the City Building Official. 4. During construction all safety regulations of the Department of Transportation shall be observed and the City shall be relieved of all responsibility from damage of any nature arising from this permit, Subject•te the same terms and conditions, the permit holder may take such safety measures, including placing and display of caution signs, as it may deem necessary in conduct of construction and maintenance work hereunder. It is the responsibility of the permittee to ?? ?? 5. All privato and all City property shall be restored to its original condition as far as practical in the opinion of the City Building Official. 6. All underground crossing Installations shall be laid at such depth as may be specified by the City Building Official. 7. The sketch covering the details of this installation shall be made a part of this pemmit. This permit is granted with the understanding that the applicant has notified all other utility users in the area covered by the permit and takes full responsibility for any damage incurred by prior installations as a result of his operations in order that they may safo guard their interests. S. It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to this permit shall not operate to create or to vest any property right in said holder. 9. Whenever the Clty decides to further exploit the City Rights of Way, any or all said 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 as required by the City Building Official at the expense of the holder of this permit. 10. The holder shall save and keep the City harmless from any and all damages, claims, or injuries that may occur by reason of the construction, 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 is not completed upon the expiration date of thls permit, the City shall have the right to complete such work and to charge the holder of the permit for all costs incurred in completed said work. 12. The holder shall post a cash or surety bond with the City Manager in the sum of $ __ dollars to guarantee perfommance of the obligations herein, and to guarantee maintenance 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 harmless in the event the holder of this permit should fall to meet any of its obligations hereunder. The bond shall also Indemnify the City for all court costs and reasonable attomeys fees In the event legal action is required to collect on said bond. / SUBMITTED BY: (PERMITTEE) Ve,e/ ZeM1 /2/ f(,021I) A 1 C Signature & Title ke.! > //.I .S/}e9 2 .� .s .�_... Address 1 90 `7 Gl5 /J)/ .3 Ol 1-D D, 7-17. REVIEWED BY: 33 c CITY OF ZEPHYRHiLLS Utilities Supervisor Date J Public Works . Date o S . '?A PRI�p " N 0 S 'WET 0-n5 " //