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1453 SUNSET POINT RDAPPLICATION 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 7HE REGlUIREMENTS 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 Printed Name Subscribed and Sworn before me this day of 19 — Signature of Notary Address NAME OF NOTARY City State zip COUNTY W COMMISSION E ;.��;�••._ .TUL�"�.—R�" . Representatives' Firm Telephone =.: {� ��;; MY COMNII,SSION /� 16g913 � ' .�"'.,'���'a. SXPIItES: Deca 18 2 Applicant must include Aerial Photograph or Scaled Drawing showing property boun i0�;;�j;��li�m#„w�k�i�;� a Tree Removal Permit. DO NOT WRITE BELOW THIS LINE Comments ��u , , � �.:-r ,:.� ., i : ' ' ' � , � . �� ? ; � , --,. . �r � � ; ,,.'f' ,� . -.�... , � .., �_� �, J�t,��fj /1 -�.<� � .�fa[.-,.�. i t^'-.1 L+-� 4� ` �`. �.� ° , Comments T� i�"� ���` ' Vti�� �r� \�_=�V� 1 _,, �--� , / -, --7 , � \J�'�._� l� `- ` _ �� �- _ � �,_ V1/ater Resource Spec. Date Urban Forester Based on the above comments and information submitted, the above removal application is: Q Approved As Submitted f�� Approved — Modified As Noted Above Signed: : °''c--u - '~-� - -�- Date: City Manager or Designee . ' � �' � ' , White — Applicant Yellow — Environmental Pink — Inspector Date fJ Denied Rev. 9/87