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. CITY OF ZEPHYRIIILLS - BUILDING DEPARTMENT DATE: I �l RIGHT-OF-WAY USE PERMIT PERMIT# �� JL' �' No construction under ground or above ground of any fecility shall be accomplished on any City Righ[s of Way witAout wri[ten approval from th City Building DepartmenL Any applicatioo for approval otcons[ruction operations on any City owned Rights ot Way shall (urnish a detsiled drawing showing the coroplete scope of the proposed work in Mplicate to the oflice of the Buildiog Offlcial for approval prior to the commencement o( any work. A copy of this permi[ is to be kept readily available at the site of the work at all times. PARCEL I.D. # CITY ROAD _�'j' �IML� R�A C� DATE (� LOCATION (Legal Description) : — A e v3Citisc�. t �lfiltTj-� �.�n .— �L-----�.7r�� --��T4l� L 1 T�-►l ��.� r 3 tUaa��J�L1� Permisaion is hereby gnoted to TgL� �� e ltY of T� •�p, Q�ay�p �� for the construction and maintenrnce of - ' — `� t��c,�i ��-�s� e C-�.� rv1 a w. _subject to the tollowing conditiooa: 1. The construchon and maintenance of such utiGty shall not interfere with the property and rights of a prior occupant. 2. All work shall be done in kceping w[th the standards of the City Streets Department and under the supervision of the City Building Ofticial, w will be notified at least one day prior to commencemeot of conatructioa 3. All materials and equipment shall be subject to inspection by the City Building Official. 4. During construc[ion all safety regulaHoos of the Department of Transporta[ion s6a11 be observed aod the City shall be relieved of all responsibility from damage of any oature oriyng [rom thia permi4 Subject to the ume terms and wndiUons, the permi[ holder may take such safety measures, including placing and diaplay of caution si�a, as it may deem neceasary in conduct of construction aod meintenance work hereunder. It is the responsibility of the permittee to ???? 5. All priva[e rnd all City properly shali be reatored to its original condition as far as practicsl in the opinion of the City Building OfficiaL 6. All under�round crossing inahlla[ians s6a11 be laid a[ such depth as may be specified by [he City Building ONicial. 7. The sketch covering [he details otthia inshlla8ou shall be made a part of this permit. This permi[ is granted with the understanding [hat the applicant has notified all other utility users in the area covered by [he permi[ and takes full responsibility for any damage incurred by prior instrllations as a reault of 6is opentiona in order that [hey may sak guard [hetr in[eres[s. 8. It is ezpressly stipulated tha[ [his permit is a license for permissive use only and that the placing of facilities upon public property pursuant to this permit ahall not operate to crea[e or to vest any property rig6t in said holder. 9. Whenever the City decides to further exploit the City Rights of Way, auy or all said poles, wires, pipes, cables, or other facili[ies and appurtenances authorized hereundeq shall be immediately removed from said Righ[s of Way, or reset or relocated thereon as required by t6e City Building Official at the expense of the holder of thls permit. 10. The holder shall save and keep the Ctty harmless Gom any and all damages, claims, or injuries [hat mwy occur by reason of the construc[ion, maintenance, and operation at 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 reques[ed is not comple[ed upon the e:pintion date of this permit, the City shall have the right to complete such work and to charge the holder of the permit (or a11 rnsts incurred in completing said work. 12. The ho►der ahall past a cosh or surety bood with t6e City Manager i¢ the sum of S dollars to guarantee performaoce of tA obligations herein, and [o guarantee maintenauce of the right�f-way described hereie for a period of one (1) year following completion of the requested installstlon. In the even[ s surety bond is poated, the surety bond shdl 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 tail to meet any of its obligations hereunder. The bond shall aiso indemoify the City for all court costs and reasoeable attorneys fees in the event lcgal ac[ion is required to collcct on said bond. SUBMTCfED BY: (Permittee) o, 4 i� q t+=, — � O� Signature & Title N t�►G Tc�C.E+n.i �c.. w.,� naa��s l4� �c►�S ��, y -- o �'�'�� 'L. 33�0 5 -�9 60 APPROVED BY: S � � � �� C1TY OF ZEPHYRHILLS �ua�� „� , Date• Utilities Supe�%p�r Date• J % J PubllcWorks �� L.�S Date: _ 1,3 M.4`� �l City Manager � / /', ( /�, � �, Date:_ �, \( I ( � l