3290 SR 580i4PPLICATION 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 THE REGIUIREMENTS OF SECTION 98, CITY CODE OF ORDINANCES REGARDING
TREE PROTECTION DURING CONSTRUCTION AND HAVE READ CITY'S EROSION AND SILTATION CONTROL POLICY
Subscri� and Sworn before me
Signature of Owner or Owners Representative /;
. this�_day of ��l.e-c. - 1 glc 2
Printed Name �
Address Signature of Notary
NAME OF NOTARY �//1GE��Q, e�i� C/CS
City State Zip COUNTY �/��S,QD �L.O U•r>' ff
COMMISSION EXPIRE�O7ARY PUBLIC. STAtE OF FIORlQ�.
Representatives' Firm Telephone . . . 15�3.
BONDED THRU NOTARY PUBLIC UNDERWRITtF"s.
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
/
Comments �; ��'" `.- , %�` __ l, � , � � f
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Comments
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Water Resource Spec
Date
Urban Forester Date
Based on the above comments and information submitted, the above removal application is:
❑ Approved As Submitted ❑ Approved — Modified As Noted Above ❑ Denied
Signed:
City Manager or Designee
Date:
Rev. 9/87
White — Applicant Yellow — Environmental Pink — Inspector
APPLICATION 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 Properry � - � � �'' :
2. Project Name ' • ` !�c 1 I � t i c r1 C �r ,,�`I���z C� � � �, � �� f � �j
3. Purpose of clearing and/or grubbing '� ' � � ' ., �i � ; -�
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 =" c'r +' ��
, 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 THE RE�UIREMENTS OF SECTION 98, CITY CODE OF ORDINANCES REGARDING
TREE PROTECTION DURING CONSTRUCTION AND HAVE READ CITY'S EROSION AND SILTATION CONTROL POLICY
r� _ �' ,-" _ iC C.�,
�� '�--� � � �� �-= ` Subscribed and Sworn before me
6: Signature of Owner or Owners Representative
'� ` this day of 1g
r',, �
Printed Name '
� `� �� '"�' l�- ,� r Signature of Notary
Address �:-
NAME OF NOTARY
City State� ` .�! ��{/� z� � COUNTY V - �
�. p .
r � i r^ J .._.- -" , �i� r.':l'� r r-; �'_
� ' ' ` {" '�' "�- '..' < -JCOMMISSION EXPIRES � " �
� r
Representafives' Firm Telephone � � t
.�
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
�
Comments I�� . �:-; ` ' ��''
.,- �` �' .. ,
� f
�
a
��?'... ,j!,r"�/'+ .%" -'� .
.--�
� � ,� . � :
. '�, -
J t. er._ ; .
Water Resource� Spec. . Date
, - -�.
Urban Forester Date
Based on the above comments and information submitted, the above removal application is:
C.J Approved As Submitted I 1 Approved — Modified As Noted Above LJ Denied
Signed:
City Manager or Designee
Date:
Rev. 9/87
White — Applicant Yellow — Environmental Pink — Inspector