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1895 VIRIGINIA ST� :�,., :� . ,�, � ;.. ; . w ; w , .. i.» y� �� ,�. �• � � ;,� ;�. � ���� .t APPLICATION FOR LAND CLEARING & GRUBBING PERMIT , � ;s CITY OF �LEARWATER � �� �. PUBLiC WORKS DEPARTMENT ' �^/ ,� % ,� � ENVIRONMENTAL MANAQEMENT DATE: +-�' �! �� .., (813) 462-674T ' R�CEIPT NO. ; A non-refundable filing fee of $10.00 is required per Resolwtion 86-9. Permit applicable for 6 months frorn date of approval. in accordance with Section 98.30, I hareby appl , for perrnit to land clear and/ rub the property described below. - 1w>�l.ocation of Property � �� �J'G.. � , 2. Project Name - _ �..� �����,/%� �,� / �� G3 � +�Ci � � . 3. Pur se of clearin andfor rubbin �%� r�./ t7 U�� ��� -- %C�. ' � � � P� 9 9 9� L.� �% t,�.2'�%�'�� ' 4. General descriptiqn of exist'rng vegetation, topography, and, surface water (including a1 ` xisting and/or proposed � .-. ditches, canals, and swales) �f//s-�' � � �G .�7��''�'G �c�. �� `�,�..�� :; ; : 5. Proposed method of debris disposal : �`� `" �i �- �" .�� 6. Date you plan to begin work ''?�/L•t�' . L�..,. 7. Proposed method of soil erosion control L L�iG�� � Lr �G.l� �� %� �� � _ S��o-Tree Verification Required ❑ Tree Removal Permit Required 1 AM AWARE AND UNDERSTAND THE REGlUIREMENTS OF $ECTION 98, C�ITY CODE OF ORpIMANCES REGARDING : TREE PROTECTIQN QURING CONSTRUCTION AND HAVE REAb CITY'S EROSION AND SILTATION'CONTROL POUCY ,, � '�� "�� -�'� f �'�'�-� - ` ���"'�"� � Subscribed and Sworn before me pnature of Owner or Owners Representativ �" •., , r. ��✓/ �.�� S"� �� �' � �' th�s.�! -day of ,�`�' ` ` � g ° .r,� Printed Name . � _�/ �� �l j ` , c.. L�� ,,r�-��`'� �r T c" � ,;};C , �,Z�"' / ��� - x . ,, I'' � !j � �� ;:Z � ��', r { e . , r' � 6p0 Signatur f Notary Address �, _ !T _ E" • �' �''�G! '.s� �7 �f 7 s ��fJ ..� C NAME OF IVOTARY f .t f ✓ �,' .:�.> `� /r.� � ,,, ,. Ciry / State , Zip COUNTY ...�.,:�' ; � �.��.t` �. . �`Li'�%c'�'flu�'i�a,� !�:..�vr`i� �� -°��'./ �y�1�`' COMMISSION EXPIRES Representatives' Firm �. �,�"" f /.t ,r,cc. � Telephone ' Applicant rnust include Aerial Photograph or Scaled Drawing sMowing property boundaries and limits of work. This is NOT a Tree RemovaF �ermit. _ ,. D NOT W TE BELOW TMIS LINE _ `; Comments -tr.c` ..,,� �' ..- �. - ' i. , , �. . f -- `, .. � ... ,. _ . � : � , ,�.. �, � � :;:� � ;:r �. � ,,� .�'" , . , q � � �...� �,. �.�,. �• . � �. �.. ...i . ..,�. . . r ' � .✓ '.. � ' fr ' �,. �� . . ,' .+'/ . � , r �. . � , . :.� . �.�-�-` ;A'?. � . —,, .� . � , � �°"s � � r .r , Wate Resource ,Spec.' ate� ; Comment � .� �: �' �r .,�' , `r' . �.r. /� � ,-;� .,� . f,,,, , - . .. - - . , ... � �� ` � � �. . . - _ '' - � . �.. ` � _S` { � i ! � � �� .�'''.:�'� �l~ % i �.���� 4 r'� � � ��/��%� �' �,.L/,'.�A.,�r=f�.�u� �'.c�,�.� ./L ,�"' ,-� .��-- ��i a rest f Date Batsed on the above comments and information submitted, the above removal application is: ❑ Approved As Submitted �pproved - Modified As Noted Above ❑ Denied `� �° ,"' Signed: '� � �1 � ��� �� ��� Date: � �e ,. . .. � . : ;: City Manager or Designee . : Rev. 9/87 E � White - APPIicaM Yellow — Environmental Pink — Inspector 9 �