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C1TY OF ZEPHYRHII,LS - BUILDING DEPARTMENT / I�ATE: '� J I� l RIGHT-OF-WAY USE PERMIT PERMIT# C� ` No construction under ground or above ground of any fscility ahr11 be accomplis6ed on aoy Cily Rig6ta of Way without written apprwel from the City Building Deparlme� Aoy apPlicaRion far app�oval d'eooatruction operationa oo any City owned Righb of WAy ahsll fia�oish a detailed drawing showiog !he complete scope of the propoeed work � trip�icate to fhe office of the BuiWing Oflicial for approval p�ior to the rnmmencemeM of any work A copy of this pemtit � to be kept readil}� aveilabie at the aibe of the work aR nll times. PARCEL I.D. # �1y gppD ��' � V DATE LOCATION (Ixgal Deacription) :� 7 l 7 l0 /"`—' F 1 Permiasion is hereby g�Med to _�C7/Lf9'�� /IOC��.� �'�/ �� /(�f of �d 7 K ��" /Z–S y� �.�(�/�/ C-��(� �� for the rnrotruction and meiMen��ce of�� ? v�t r�.gr�a �'-�fv Cxl /c.>> �— Cu�c.hu�: J _subject to the folbwing conditions: 1. The constn�ction and memte�mnce of such utility shall not i�erfere with the property and righb of a p�ior occupant 2. All worit shaB be dooe in kcep�g with the sta�dsrds of t6e City Streeb Depr�ment and under the supervision of fhe City Building Oflicial, who will be notified at lea9t one day prior to rnmmeocement of conatruclion. 3. All materinls end equipme�N shsB be subject to impection b,y ffie City BuiWing Oflicial. 4. During construcNon ad aafety r�ationa of t6e Departme� of Tramportation ahall be observed end the City shall be relieved of all responaibiHty Tran dsme�e of � nature arising fi�oo� t6is pe�mmt, Su6ject to fhe same terms and coodition,�, the pernrt holder may take such sefety measwes, including placing and dispFay of caution si�s, � it mey deem necessary in conduct of caostruction and mpintenance work hereunder. It is the responsi6ility of the perntiltce to ???? 5. All private and all City properly shsll be restored to its origircd comlitioo aa far a�s practicai in the opinion of fhe City Building Oflicial. 6. All underground croasing it�ts�tio� sha11 be laid s�t auch depth as m�y be apeci5ed by the CKy B�eWiog OfliciaL 7. The sketch coveriog tlre details otthis i�i�llation a6a� be made a part of thia pernit Th� permit � graoted witb the ande�atandi�g that lhe applicant has noti8ed eH other utility users in the a�ea rnvend by the permit and tskea full responaibility for a�ry da�nage incw�red by prior inatallatior� as a reauk of Iris operations in order t6at they mry srfe guard their a�teresta 8. It is expressly atipulrted that tlas pe�mit is a license for pe�miasive uae o� and that the placi� of facilities upoo public property� pursuaM to this pemtit sha11 not operate to create or to vest aoy property right in said holder. 9. Whenever ihe City decides to turther ezploit t6e Crty Righta of Wsy, nny or all aeid poks, wircs, pipea, caWea, or otlrer fec�ities and appurte�nces authorized hereunder, ahell be i�madiahiy removed from said Righb ot Way, or reset or relocated thereon es required by the City Building Oflicial at the eapense of the holder of tltis per�oit 10. The hoWer shall save and keep the City harmless from any and all damagea, claims, or injuries th�t may occ�a by reason of the co�truction, mai�enence, and operation otaeid facility. 1 L The holder shaB comple�e the requested work within d�ys or thi4 permit ahsll become nu11 and void. In the event the work requested is not rnmpleted upon the ezpiration date of tlm pernat, t6e City s6a11 have the rg6t to rnmplete suc6 wo�ic nnd to charge the holder of the permlt for a11 costs ineurred in completing said wo�ic. 12. The holder ahall pod a cash or s�a�ely bond witl� ihe City Man�,.er in the wm of S dollara to guarantee perl'onnance of tl�e obtigations herein, and to guaranhe maintenance of the right-of-way deacribed herem for a periad of ane (1) year folbwiog rnmpktion of the requested installs�tion. In the event a surcty bond ia poeted, the s�a�ety bond aha11 be u�ade payable to the City and ahall oblig�e the aurety to hdd the City harmleas in the event t6e holder otthia pennit shouid fail to meet any of ils obligationg hereunder. The bond shall also e�demnify the City for all rnurt costs and reasooabk attw�neys fees in the event legal actioo ig req�ered to rn�kct on seid bond, SUBMI D BY: (Pem�ittee) / / L � � �/ '= Sig�t�e & Title � OG � /�7 �✓ G' Address ��fS z �j� �� 1 ��t� C../�� /–/ 3 �� C ��) �� — C� S"zz ��-� �'�s�� APPROVED BY: CITY OF ZEPHYRffiLLS Building O�cial Date• Utilities Supervisor Date• Public works �� Nd O�V CcT�,S N Date• City Manager Date•