2144 CALUMET STALI
APPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PUBLIC WORKS DEPARTMENT
ENVIRONMENTAL MANAGEMENT DATE
(813) 462 -6747 RECEIPT NO.
A. non - refundable filing fee of $ 10.00 is required. Permit applicable for 6 months from date of approval.
In accordance with Section 50.22,1 hereby apply for permit to loD-d clear and /or grub the property described below,
1. Location of Property:
2. Project Name: S. j AIA_Ld53 TAINT xA- y�rLS'
3. Purpose of clearing and /or grubbing: XNew Construction p Demolition p Tank Removal p Other
4. General description of existing vegetation, topography, and surface water (including all existing and /or pro-
posed ditches, canals, and swales) N6 U ej a 1'� C 0S'flLu�.7i vJ
15 0uain- Ex LL Q46Lt-
5. Proposed method of debris disposal JJ 2 f IL �-
6. Date you plan to begin work
7. Proposed method of soil erosion control �!
8. "o -Tree Verification Required p Tree Removal Permit Required
I AM AWARE AND UNDERSTAND THE REQUIREMENTS OF SECTION 52.08, CITY CODE OF ORDINANCES REGARDING
T2. PROTECTION DURING CONSTRUCTION AND SECTION 50.43 REGARDING EPOSION AND SILTATION CONTROL.
9
Sigldidcb of Owner or Owntsrs Representative
Printed Name
12-S4--A S, 44 f 6t4LNN O AU c
Address
CLc4O -W-A TZw-
City ,/ State Zip
°F�'LL_100 4- &c5 -5&C- iA-rG 8r3-4-43104,7
Representatives' Firm Telephone
Applicant must include Aerial Photograph or Scaled Drawing showing property boundaries and limits of work. This is
NOT a Tree Removal Permit.
DO NOT WRITE BELOW THIS
Comments , E yEN7 41a 49f DRIS 6-1 Cnll'EA-Nd- 1,2E i r R /d- NT -aF � 6JA,
OR c�Xcsn�E S�?9;lZr� R�lry SA�Si+^s SPPG�9�-
- let., M �, oe 5o d // ais �i a l-ea_f C ON Co mDin Cotes trVC7�0 n.
Environmental Inspector Date
Based on the above comments and information submitted, the above clearing & grubbing application is:
U Approved As Submitted .Approved - Modified As Noted Above O Denied
��
Signed: Dote.
City Manager or Designee
6
APPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PUBLIC WORKS DEPARTMENT
ENVIRONMENTAL MANAGEMENT DATE
(813) 462 -6747 RECEIPT NO.
A. non - refundable filing fee of $ 10.00 is required. Permit applicable for 6 months from date of approval.
In accordance with Section 50.22,1 hereby apply for permit to loD-d clear and /or grub the property described below,
1. Location of Property:
2. Project Name: S. j AIA_Ld53 TAINT xA- y�rLS'
3. Purpose of clearing and /or grubbing: XNew Construction p Demolition p Tank Removal p Other
4. General description of existing vegetation, topography, and surface water (including all existing and /or pro-
posed ditches, canals, and swales) N6 U ej a 1'� C 0S'flLu�.7i vJ
15 0uain- Ex LL Q46Lt-
5. Proposed method of debris disposal JJ 2 f IL �-
6. Date you plan to begin work
7. Proposed method of soil erosion control �!
8. "o -Tree Verification Required p Tree Removal Permit Required
I AM AWARE AND UNDERSTAND THE REQUIREMENTS OF SECTION 52.08, CITY CODE OF ORDINANCES REGARDING
T2. PROTECTION DURING CONSTRUCTION AND SECTION 50.43 REGARDING EPOSION AND SILTATION CONTROL.
9
Sigldidcb of Owner or Owntsrs Representative
Printed Name
12-S4--A S, 44 f 6t4LNN O AU c
Address
CLc4O -W-A TZw-
City ,/ State Zip
°F�'LL_100 4- &c5 -5&C- iA-rG 8r3-4-43104,7
Representatives' Firm Telephone
Applicant must include Aerial Photograph or Scaled Drawing showing property boundaries and limits of work. This is
NOT a Tree Removal Permit.
DO NOT WRITE BELOW THIS
Comments , E yEN7 41a 49f DRIS 6-1 Cnll'EA-Nd- 1,2E i r R /d- NT -aF � 6JA,
OR c�Xcsn�E S�?9;lZr� R�lry SA�Si+^s SPPG�9�-
- let., M �, oe 5o d // ais �i a l-ea_f C ON Co mDin Cotes trVC7�0 n.
Environmental Inspector Date
Based on the above comments and information submitted, the above clearing & grubbing application is:
U Approved As Submitted .Approved - Modified As Noted Above O Denied
��
Signed: Dote.
City Manager or Designee
6
Js [. -it,t! (�, '1': tt,t.tAY L':u7:
Roy G. Harrell, Jr. 1
m
Chouan. St. POICISDUrt,
Joe L Devic, Jr.
Vice Chairman. Woucr+rrlo
Curtis L low
3ecrelury. l4rnd ^.i' i.okes '
Sally Thompson
Treasurer.'6mCrO
James L Allen
$usrneil
Ramon V Campo
9rarrdori l
James L Cox
i.okelor4 t
Qo*ecco M. Eger
SCrosoto
John P. Horiloo. IV
Brcdar.fun
Jtimes E. Modin
ST, Fe!ersturg
Virginia 5. Roo
Tompr,
Peter G. Hubbell
ExoCUtivt- D1,ector
Mark 0. Forrtll i
A _-Mant Executrve OiroC:Or
Edward B. Helvan,,OA
Goncrol Counsel
Southwest Florida
Water ManagerneTit District
23 7U Braao Street - 5rocksvllle. Florlclo <v(.i•c?t?�: SC'0•d��.1476 {FlDncja Cr,hi) or
r35.2-1 '94-721 1 . SUNC to 628 -G'• 50 D. C.'. Nt.,rr)cr -r ;nly lR!7tiCJ0 Cnly): 1.8C;i) -2 j 1 -6103
'Wi Hgnwotr X1 Neer„ I'V' Car ;.% a:u,evcrC i54ir0.xt7 car `'oy :703';ighwa; 44'4&'es
-^:KJ, Rprcc J2 Jic1`9 Bar! "W PO(i 3383(); 7W Yar.�ce. Ficrido 3t�9? 3��� l f rill •a. Fttmo 14-A -4•'.9Go
,. d7� Jo„i�; .a ! I� '?1� ;5��1 I -a9:• &� CG it ;\J•t 7C Y 4�rr ;'j'i? 94i)•' &!21:
SvNC ^1d [,i9?C ?3 5:'NGr:M 5'.�" �(i S:f : � Y ;:6•G'�i)
FAX TRANSMITTAL LOG
FOR
ThMPA XPEGULATION DEPARTMENT
(813) 987 -6746
FAX TO:
ORCANI7.ATION:
ATTENT ICN :
FAX NUMBER :
NAME:
FAX FROM:
NO OF FACES (INCLUDING THIS ONE)
I DATE SENT:
i
TIME SENT:
CONFI MATION REQUESTED: YES I-•� NO
TAMPA REGULATION DEPARTMMIr
COMINO HILI.SACR'OUGS AND PIMMLAS 10011"IES
SHE AMEBIC -N-N WITH DISABILITIES A= IKYURXATION
- V C11r;
The Southwest Florida Water Management pis:_rict (District) does not
discriminate upon the basis of any individual's disability status.
This non- discrimination policy involves every aspect of the
District's functions including one's access to, participation,
employm6nt, or treatment in its programs or activities. Anyone
requiring reasonable accommodation as provided for in The Anericars
with Disabi? ; ties Act, st•lou1 contact_- Eileen Rorabachar, tele
(813) 985 -7481 or 1 -8100- 836 -079? (Florida) ,
1 -800- 231 -6103 (Florida); FAX (1813) 987 -674
TAE1419196
JUN 171996
T'rctt�Jt
Q11,41/it1, I '' - CENTRAL pERNNTTING
%CITY Cie CLEARWATER
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1'4.8' _ , �' �R Rt $
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n REMOVE FENCE iE a \ -(IE„gN \U C�
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1 STQf�Y CAS AND SrrE ^DEUVER TQ: in
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