3024 KENTUCKY AVEAPPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PUBLIC WORKS DEPARTMENT
ENVIRONMENTAL MANAGEMENT DATE
(813) 462-6747 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
, . • �
Subscribed and Sworn before me
Signature of Owner or Owners Representative
this day of 19
Printed Name � � • .
'.
Signature of No ry �����
Address
NAME OF NOTARY :G•'��.���=`�"���"'
City State Zip COUNTY : ,
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a ; C�MM�SS��N E"1vfY'�iiR�,P'Ui3LIC 37'A'i�Q��' �'�ORII9A•
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Re resentatives' Firm ^ Tele hone �����pr£����� p
P P g�NDED TkdRU NOTARY PUBLIC UNDERWRTi'ERS.
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 .� � ____._ �
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Comments
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Water Resource Spec. Date
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Urban Forester Date
Based on the above comments and information submitted, the above removal application is:
�J Approved As Submitted ❑ Approved — Modified As Noted Above
Signed:
City Manager or Designee
Date:
White — Applicant Yellow — Environmental Pink — Inspector
❑ Denied
Rev. 9/$7
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 Property ' ' ' � ' � � �- � • �
2. Project Name � �� � � � � � , � � ��� �'�r �� '_. �� r ! . ; „ �
3. Purpose of clearing and/or grubbing � � �- � � `-� ' - ' - � � - ' ' � � �- `'c= r' � 4� J
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 ��� - F��.-
6. Date you plan to begin work t � r� • i` �., ! �r ��
7. Proposed method of soil erosion control " T A K �� � r I I� �f C��I Lt '- ( �� �' r:"� �
' , i '� r, , � i i � � �r � t--f�
8. ❑ No-Tree Verification Required C� Tree Removal Permit Required � x'� �� --� ' �
I AM AWARE AND UNDERSTAND 7HE REC]UIREMENTS OF SECTION 98, CITY CODE OF ORDINANCES REGARDING
TREE PROTECTION DURING CONSTRUCTION AND HAVE READ CITY'S EROSION AND SILTATION CONTROL POLICY
� 4 .
Signature of Owner or Owners Representative
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ri_��� c � � c.��.
Printed Name
-f � � ,
Address
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City State
Zip
Subscribed and Sworn before me
this �����day of r ��..,�-�?�-X_�� `� 19 ,��-`�
T���+
i ',__.ti �_.. - _...
T � Signature of Notary (
NAME OF NOTARY
COUNTY '���� ,� � � f ��
COMMISSION EXPIRES
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 � r"�'m"�
1
DO NOT WRITE BELO_W_THIS LINE
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Water Resource Spec. Date
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Comments L .�%Cl�� �%�'r`-!% " �%``-�=�� : �`_
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Urban Forester
Based on the above comments and information submitted, the above removal application is:
i_J Approved As Submitted I i Approved — Modified As Noted Above
Signed:
City Manager or Designee
Date:
White — Applicant Yellow — Environmental Pink — Inspector
Date
C ] Denied
Rev. 9187