801 BRUCE AVE��� =-
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APPLICATION FOR LAND CLEARING & GRUBBING PERMIT
CITY OF CLEARWATER
PLANNING DEPARTMENT
(727) 562-4741
DATE
RECEIPT NO.
A non-refundable filing fee of $10.00 is required. Permit applicable for 6 months from date of approval.
In accordance with the Community Development Code, I hereby apply for permit to land clear and/or grub the property described
below.
1. Location of Property: o V� 1'S 1� (/e ��� '(-.����� 1Ar'�R [J���i � l
2. Project Name: � 1'J �aQ..`t,1`Z._ �/�-1�c Q J�- -��Q ( J� f.J r4M
3. Purpose of clearing and/or grubbing: ❑ New Construction ❑ Demolition ❑ Tank Removal ❑ Other
4. General description of existing vegetation, topography and surface water (including all existing and/or pro osed ditches, canals
and swales): O�� l V � '`�� ' �J
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5. Proposed method of debris disposal: �N �( ���� ��J1'�� C� 48 "" (t l��✓1- Cs,�,Atl git, f Y!1'
6. Date you plan to begin work: F1�_ J �1 d�lJ � �6 Scsl �� Z �
7. Proposed method of soil erosion control: CJ� �� �� /l j� ,
8. ❑ No-Tree Verification Required ❑ Tree Removal Permit Required
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I AM AWARE AND UNDERSTAND THE REQUIREMENTS OF ARTICLE 3, DIVISION 12 REGARDING TREE PROTECTION DURING
CONSTR,IIGTION AND ARTICLE 3, DIVISION 7 OF THE COMMUNITY DEVELOPMENT CODE REGARDING EROSION AND SILTATION
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of Owner or Owner's
Printed Name
$ � � 3 D��C.� � � �..�. � .
Address
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Cit � State Zip
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Representatives' irm
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Telephone Cell
Applicant must include Aerial Photograph or Scaled Site Plan showing property boundaries and limits of work. This is NOT a tree removal permit
DO NOT WRITE BELOW THIS LINE
Land Resource Comments:
Based on the above comments and information submitted, the above clearing & grubbing application is:
❑ Approved ❑ Approved - Modified as Noted Above ❑ Denied
Signed:
City Manager or Designee
Date:
Rev. 03-2010
Owner
Email
NO TREE VERIFICATION
OR
NO TREE REMOVAL PERMIT REQUIRED VERIFICATION STATEMENT
CITY OF CLEARWATER
PLANNING & DEVELOPMENT DEPARTMENT
(727) 562-4741
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Cell Phone �
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Owner's Representative ��� N� S �� � � �„ff��� l� Phone �$ � ' C� � � 7
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Email � ��'1.� � � � �/�-h�lU -�QIN�, Cell Phone Li�/ ' �i� ? 7 �
Addi
City
Address of Proposed Construction
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Clearwater, Florida
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I hereby certify that the information contained herein is true and accurate and that I am the legal owner of the
subject property or have legal authority to execute this form on behalf of the property owner. I am aware that
any deviation from the information submitted with this form shall be considered a violation of the �ommunity
Development Code. In accordance with Section 4-1205, Community Development Code, I request a release from
the provisio of the tree removal permit section to allow the issuance of a building permit at the above location
becaus ne of the following conditions exists:
PROTECTED TREES EXIST ON THE SITE as defined in Section 8-102 (non-prohibited species greater than four
inches at 4.5 feet above grade), but ARE NOT REQUIRED TO BE REMOVED FOR CONSTRUCTION purposes,
thus no tree removal permit is required. I further understand that these TREES MUST BE PROTECTED FROM
DAMAGE BOTH BEFORE AND DURING ALL CONSTRUCTION ACTIVITIES ON THIS SITE as provided in Section
3-1205 of the City Code of Ordinances (A site plan is submitted with this request).
❑ NO PROTECTED TREES EXIST ANYWHERE ON THE SITE of the proposed construction as defined in Section
8-102 (non-prohibited species greater than four inches at 4.5 feet above grade).
PRINTED NAME
SIGNED
.�� NnII S �- d
Owner or Representative
_ G/
Sig ture of Owner or Represen
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White-Planning Yellow-Applicant 10-10
SCALE: 1 "= 20'
REVISED:
CECEND:
BAl — Benchmork CB — Concrete Block CL — CenteNine CM — Concrete Afonument
ELEV — E7evotion fN0 — Found IP — Iron Ptp e IR — Iron Rod ASP — Asphalt
LS/ — Land Su�yor Registfation Num6er N/T — Noll 8 Tob Nd�D — Noil k Disk
M.N. — Manho7e PRM — Permonent Aaierence Monument R/W — Right Of Woy
CONC — Lbncrote P.C. — Point OF Curwtum P.T. — Point 07 Tangent
P.R.C. — Palnf Ol Reverse Curvotuie P.QC. — Polnt Of Compound Curve CA. — Chord
P.P. — Porer Pob W.Af. — Water MeMr R.R.S. — Roil,vad Splke RAD. — Rodius
R— Record 0— Oeed Al — Meas�md C— Calculoted O.B. — Oeed 800k
P.B. — Plot Book O.R. — O�c1a1 Reeord 9ook PG — Paqe PVM! — Povement
P.O.B. PoM! O( Bcoring P.O.C. Point 0/ Commencement CH.B. Chord Beorinq
R.P. — Rodiva Point CIF — CAain Unk Fence P.C.P — Permanent Control Pant
P.R.M. — Fermonsnt Refsro�ce Monumant
GfNERAL NOTES:
1. No inahvmenfs o! record reFlectJng msements, righta—oi—way, and/or ownenhip werr
fumislieq, exeepf as ahown.
2. No undeiground 7mproremente locoted except as ehown.
3. K ekwUons aro shown, such elevalions aro based on N.G.V.D. f929 (AiSL = 0.00).
4. Declarution ls made to ori9inal purcAaser of Ure survey. tt!s not iransferable to
oddlGonal lnstitudons or subaequent owne�,
S��u or hos mode no investigation or indepenCent seorch for eosemanfs of record,
+ en ctfve covenants, ownershlp tltla evidence, or any ather facts
t�' t/p;t u�n {�.tltpg� earch may dieclose.
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This property lies within Fiood Zone AE as depicted on Ffood lr�surance
Rate Map Community Panel # 125096 0007D Dated: 8-19-91
BENCHMARK:
BASE FLOOD ELEV,4TION: 11.0'
BASIS OF BEARINGS: THE EAST R/W LINE OF BRUCE AVE.
BOUN�ARY SURVEY.•
LOT f, BLOCK 23, MANDALAY, ACCORDING TO THE MAP OR PLAT THEREOF AS
RECORDED lN PLAT BOOK 14, PAGES 32 — 35, OF THE PUBLIC RECORDS OF
PINELLAS COUNTY, FLO�. �
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BLOCK 23
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OFFlCE LOCATION: 1305 SOUTH HfGHLAND AVE.
CLEARWATER, FLORIDA 34616
NOT VALID WJTHOUT THE SIGNATURE AND
THE ORIGlNAL RAISED SEAL OF A FLORIDA
LICENSED SURVEYOR AND MAPPER.
PREPARED FOR AND CERTIFIED T0:
CAROL S. ALEXANDER
AWERB,4CH & A4URPHY P.A.
AMERICAN PlONEER TITLE INSURANCE C0.
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FND 4k4• ��, BLOCK 23
(NO ,�) O
0.93' NOR7N
0.02' FIST
P. P.
N `►\ LS 3035
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TARGET LAND SURVEYING. � °
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P.O. BOX 663 a�
DUNEDIN, FL 34697-0663 PH:(813) 784- ; �,
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! hereby certify that fhis survey was made under rr Q O O a�
charge and meets the mrnimum Technical Standards W�� � o
by the Florida Board of Professional Land Surveyor p a ��
61 G 17, Florida Administrative Code, pursuant to Sec V e� a' Q?
Florida Statutes � � U �i
� Field Survey:_ � � Q � �
,���'u �-�1-i ��s FB# 325 o a o 0
—�` Philip C. Stock � N� Z-'.
RLS #3035, LB #5570 J o b# 9 7 i r��� �rn
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2-13-97 Drawn By: D. ap m o Q N
DAiE OF CERTIFICATION Surveyed By: F .