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CITY OF ZEPHYRHILLS-BUILDING DEPARTMENT /��(f/ ' DATE: �L�� 2i�1 �-( RIGHT-OF-WAY USE PERMIT PERMIT# I(� No construction under ground or above ground of any facility shall bc accomplished on any City Rights of�Vay without written approv�l from the Cit,y I3uilding Dcp�rtment.Any application for:�pproval of construction oper:�tions on Any City owned Rights of Way shall furnish a detailed drawing shorving the complete scope of the proposed work in triplicnte to the office of the Building Official for�pproval prior to the commencement of any work.A copy of this permit is to bc Icept rc:�dily:�v:�ilable at the site of the work;�t all times. PARCEL I.D.# CITY ROAD �G�1� ��l� "�� S I� DA7'E�� LOCA1'ION(Lcg:il Dcscription): I� •. , / ��-r� �Y'c� ��`5 .� ' � � r�.� O\�'7 �1ta� Sv T �t`.�'Y`� V Y�.�-e✓_ � ��— - 5 � ��-� ��z. ::�5�� -F �-E �-�-5�� w �,�� ,��1�� 1 �x o,� `_�:J .�-�L- S��C_ n"� St��...-i-� il v � Permission is hereby grAnteJ to of , for the constrnction and mainten�nce of- _subject to thc folluwing conditions: 1. Tl�e construction:�nd mAintenance of such utility sh:ill not interfere with the property and rights of a prior occupant. 2. All work shall bc done in keepinQ�vith thc standards of the City Strcets Dep:vtment and undcr the supervision of the City Building Official,who will be notified at least one day prior to commencemcnt of construction. 3. All materials and equipment shall be subject to inspecfion by the City Building Official. 4. During construction all s:�fety regul�tions of the Departmrnt of Transportation sh:�ll be observed and fhe City sh�ll be relieved of all responsibility from damage of any nature arising from this permit.Subjcct to the same terms and conditions,the permit holder may tnkc such safety me:�sures,including placing and display of caution signs,as it may.deem necessary�n conduct of construction and maintenance work hereunder. It is thc responsibility of the permittee to?'.''?? 5. All priv:�tc and all City properly sh�ll be restored to its ori�inal condition as f:�r as practic�l in the opinion of the City Building OfTicial. 6. All underground crossing installations sh�ll be I�id at such depth as may be specified by thc City I3uilding Offici�l. 7. The sketch covering thc detAils of this install:�tion shall be made a part of this permit.This permit is gr�nted with the understanding that the applic�nt has nutified all other utility users in the are:�covered by the permit and takes full responsibility for any damage incurred by prior installations as a result of his operations in ordcr that they may s�fe guard thcir intcrests. 8. It is expressly stipulated th:it this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to tl�is permit shall not operate to create or to vest Any property right in said holder. 9. �Vhencver the City decides to further exploit the City Rights oT�Vay,�ny or all said poles,wires,pipes,cables,or other G�cilities and Appurtenances authorized hereunder,shall be immediately removed from said Rights of�Vay,or reset or reloca�ted thereon as required by the City Building Offici�l at thc expense of the holJer of this permit. ]0. The holder sh:�ll save and keep the City h:�rmless from any and all d:�mages,claims,or injuries that may occur by reason of the construction, maintenance,and operxtion of s�id facility. I1. 7'he holder shall complete the rcyuested work within days or this permit shall become null and void.In thc evcnt the work rcquested is not completed upon the expiration datc of this permit,the City shall havc the right to complete such work and to charge the holder of the permit for�II costs incurred in completing s�id work / 12. The holder shxll post:�cash or snrety bond�vith the City Manager in the sum of$ dollars to guarantec performance of the obligations herein,And to guarantcc maintenance of thc right-of-way describeJ hcrein for a period of one(1)year following completion of the requested installation.In thc event�surety bond is posted,the surety bond shall be made payable to thc City and sh�ll obligate the surety to hold the City harmless in the event the holdcr of this permit should fail to meet:�ny of its oblig�tions hercundcr.The bond shall Also indcmnify the City for all court costs and rcnsonable attorncys fces in the cvent Icgal action is required to collect on said bond. SUBMITTED Bl': , (PcrmitteC) V�1r ti Z O� . � l ' Signature&Titlr�� `�C) ��et'✓� Jv�-�w=1� Addres� ��6 � � , 1 e�-e c..c��-,-. �C�Y��t�p..�- i-e-W.`01�2 '1�.✓�•r�-:� ��L 3 3�3? APPR01'ED 13Y: ' CITI'O�ZEPHYRIIILLS Building Official Date: Utilitics Supervisor v:�r�: -�a Public�Vorks � ` Datc: City Mxnager Date• �