2989 UNION STAPPLICATION 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.
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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 REGTUIREMENTS 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 19
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— �� � Signature of Notary
NAME OF NOTARY
Zip COUNTY N8T14'�Y PU6L--I-C STATc "� FtORIDA
COMMISSION EXPIRE�p Coaunissior� ExP. �Gv.29,1993
Representatives' Firm Telephone
Applicant must include Aerial Photograph or Scaled Drawing showing property boundaries and lim�its of work. This is NOT
a Tree Removal Permit.
DO NOT WRITE BELOW THIS LINE � -- _
Comments # ��- ° �
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Comments �f`�,�•= � �� � r"�> ''
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Water Resource Spec
Drate
Urban Forester Date
Based on the above comments and information submitted, the above removal application is:
❑ Approved As Submitted �1` Approved — Modified As Noted Above C 1 Denied
Signed:
City Manager or Designee
White — Applicant
�
Date:
Yellow — Environmental
Pink — Inspector
Rev. 9/87