2623 - 2641 MCCORMICK DRAPPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PUBLIC WORKS DEPARTMENT
ENVIRONMENTAL MANAGEMENT
(813) 462-6747
DATE
RECEIPT NO.
A non-refundabie 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 � `' ` ' " r '�' "
2. Project Name ;,;= ^ l���i- t
3. Purpose of clearing and/or grubbing '�''' '- `� '' � r� l
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4. General description of existing vegetation, topography, and surface water (including all existing and/or proposed
ditches, canals, and swales) r "
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5. Proposed method of debris disposal ',,� r`%r `" � JJ' �`�! . F '�''i���
6. Date you plan to begin work -- r�� �� '` ` ` /
7. Proposed method of soil erosion control . �'' -' ��°�f'a %�%��`� ` `� � '� - �`''�='%��'° '
8. ❑ No-Tree Verification Required V,�'Tree Removal Permit Required
I AM AWARE AND UNDERSTAND THE REG�UIREMENTS OF SECTION 98, CITY CODE OF ORDINANCES REGARDING
TREE PROTECTION DURING CONSTRUCTION AND HAVE READ CITY'S EROSION AND SIITATION CONTROL POLICY
Signature of Owner or Owners Representative
Printed Name
, /.�11�" �
Subscribed and Sworn before me
�, f this day of 19
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` " ;' � � �r' `" Signature of Notary
Address
, , ,F_ �' G�,,, , NAME OF NOTARY
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Ciry State � Zip COUNTY _�AR����AN EXpTE ^`
.�.*c NOV.29,1y�3
� r-. • r(. THRU 6ENERAI INS. U�iO.,
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Representatives' Firm Telephone � =
Applicant must include Aerial Photograph or Scaled Drawing showing property boundaries and limits of work. T�his is NO,'�
a Tree Removal Permit. �- ��
DO NOT WRITE BELOW THIS LINE �
Comments '
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Water Resource Spec. Date
Comments �=�1�.' /� 'i C .'��J ) � �' /�'�:.. � -= �{ _ �' /� t- , _
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Urban Forester Date
Based on the above comments and information submitted, the above removal application is:
C-1 Approved As Submitted LI Approved — Modified As Noted Above ❑ Denied
Signed:
City Manager or Designee
Date:
White — Applicant Yellow — Environmental Pink — Inspector
Rev. 9/87