23654 US HWY 19 NAPPLICATION 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
I � Tree Removal Permit Required
I AM AWARE AND UNDERSTAND THE REOUIREMENTS 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 Notary
Address
NAME OF NOTARY
City State Zip COUNTY
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.
DO NOT WRITE BELOW THIS LINE
Comments �
Comments
�
�
Water Resource Spec.
Date
. Urban Forester Date
Based on the above comments and information submitted, the above removal application is:
❑ Approved As Submitted C=l Approved — Modified As Noted Above L_� Denied
Signed:
City Manager or Designee
Date:
Rev. 9/87 I
White — Applicant Yellow — Environmental Pink — Inspector