2875 SR 580APPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PUBLIC WORKS DEPARTMENT
ENVIRONMENTAI 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 0 Tree Removal Permit Required
I AM AWARE AND UNDERSTAND THE REQUIREMENTS OF SECTION 98, CITY CODE OF ORDINANCES REGARDING
TREE PROTECTION DURING CONSTRUCTION AND HAVE READ CITY'S EROSION AND SILTATION CONTROL POLICY
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Signature of Owner or Owners Representative
Printed Name
Address
City State
— Subscribed and Sworn before me
this day of 1 g
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— Signature of Notary � � � : �,
NAME OF NOTARY t� C�.
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zip COUNTY C�
— COMMISSION EXPIRES
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 LINE
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Comments
' Water Resource Spec
Urban Forester
Based on the above comments and information submitted, the above removal application is:
❑ Approved As Submitted [;�'lApproved — Modified As Noted Above
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Signed:
City Manager or Designee
; .
Date:
White — Applicant Yellow — Environmental Pink — Inspector
Date
Date
❑ Denied
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f Rev. 9/87