1610 MISSOURI AVEAPPLICATION 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'� � � � �
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
., �
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I AM AWARE AND UNDERSTAND THE REQUIREMENTS 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
�
Address
Subscribed and Sworn before me
this day of 19
..-
Signature of Notary
i
NAME OF NOTARY
City State Zip COUNTY �TARY PUDLIC STATE !� FI ORIDA
SION EXP. NOV.29,1993
� - . COMMISSION EX�,9 THRU 6ENERAL INS_ U3iD
Representatives' Firm Telephone
Applicant must include Aerial Photograph or Scaled Drawing showing propert�,r boundaries and limits of work. This is NOT
a Tree Removal Permit.
DO NOT WRITE BELOW THIS LINE
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Comments
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) , Water Resource Spec. Date
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Comments / J `� ��,C �,�_ ,f �;!� � _ � j , , -
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Urban Forester
Based on the above comments and information submitted, the above removal application is:
❑ Approved As Submitted I_! Approved — Modified As Noted Above
Signed:
City Manager or Designee
White — Applicant
�
Date:
Yellow — Environmental
Pink — Inspector
Date
f � Denied
Rev. 9/87