3450 LANDMARK DRAP�=�.iCA�`I�r� ��3�3 �AND CLEARING & GRUBBIIVG PERMIT
��TX C3F �LEARWATEf�
���LIC WORKS DEPARTMENT
E�I��R(JNMENTAL MANAGEMENT
(813) 462-6747
DATE
RECEIPT NO.
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A non-refundable filing fee oa a4 ^��:? �:s ;�c��:A��r.� ��:�� Resolution 86-9. Permit a�piicatrle fior 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 . � C�' '
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 - c r' �
. , .. ; �
6. Date you plan to begin work .� �-t" ��
7. Proposed method of soil erosion control :�- �"� � % �
8. No-Tree Verification Required ❑ 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
Signature of Owner or Owners Representative
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Printed Name
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Address _ `._
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City State Zip
Subscribed and Sworn before me
this � � �day of
19
�� 7� Signature of Notary �
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NAME OF NOTARY °���
COUFy '' __ NOTIIRY PUBLIC STATE OF FLORIDA` _
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COMiVIiSSION EXP� THRU 6�N�RAL IltS• UND• _
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.
Comments
Comments
0
_ DO NOT WRITE BELOW THIS LINE
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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
Signed:
City Manager or Designee
Date:
� White — Applicant Yellow — Environmental
Pink — Inspector
U Denied
Rev. 9/87