1453 SUNSET POINT RDAPPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PUBLIC WORKS DEPARTMENT
ENVIRONMENTAL MANAGEMENT
(813) 462-6747
DATE
RECEIPT NO. _
A non-refundable filing fee of $10.00 is required per Resolution 86-9. Permit applicable for 6 months from date of approval.
In accordance with Section 98.30, I hereby apply for permit to land clear and/or grub the property described below.
1. Location of Property
2. Project Name
3. Purpose of clearing and/or grubbing
4. General description of existing vegetation, topography, and surface water (including all existing and/or proposed
ditches, canals, and swales)
5. Proposed method of debris disposal _
6. Date you plan to begin work
7. Proposed method of soil erosion control
8. ❑ No-Tree Verification Required ❑ Tree Removal Permit Required
I AM AWARE AND UNDERSTAND 7HE REGlUIREMENTS OF SECTION 98, CITY CODE OF ORDINANCES REGARDING
TREE PROTECTION DURING CONSTRUCTION AND HAVE READ CITY'S EROSION AND SILTATION CONTROL POLICY
Signature of Owner or Owners Representative
Printed Name
Subscribed and Sworn before me
this day of 19
— Signature of Notary
Address
NAME OF NOTARY
City State zip COUNTY
W
COMMISSION E ;.��;�••._ .TUL�"�.—R�" .
Representatives' Firm Telephone =.: {� ��;; MY COMNII,SSION /� 16g913
� ' .�"'.,'���'a. SXPIItES: Deca 18 2
Applicant must include Aerial Photograph or Scaled Drawing showing property boun i0�;;�j;��li�m#„w�k�i�;�
a Tree Removal Permit.
DO NOT WRITE BELOW THIS LINE
Comments ��u , , � �.:-r ,:.� ., i : ' ' ' � , � . �� ? ; � , --,. . �r � � ; ,,.'f' ,� . -.�...
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Comments T� i�"� ���` ' Vti�� �r� \�_=�V� 1
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V1/ater Resource Spec. Date
Urban Forester
Based on the above comments and information submitted, the above removal application is:
Q Approved As Submitted f�� Approved — Modified As Noted Above
Signed: : °''c--u - '~-� - -�- Date:
City Manager or Designee
. ' � �' � ' ,
White — Applicant Yellow — Environmental Pink — Inspector
Date
fJ Denied
Rev. 9/87