HomeMy WebLinkAboutPC-Land_ClearingCITY OF AUBURN DEPARTMENT OF PUBLIC WORKS
BUILDING DIVISION
I ONn CI FARING PFRMIT OPPI ICOTION
Rim niNC. fNVISInN PHONF- 931_3010
DATE SUBMITTED PROJECT NAME APPLICATION NO.
OWNER: PHONE/HM PHONE/WK
ADDRESS CITY/ST/ZIP
CONTRACTOR: PHONE PHONE/PRJ
ADDRESS CITY/ST/ZIP
STATE CONTRACTOR'S DEPT. OF REVENUE INDUSTRIAL INSURANCE
REGISTRATION NO. SALES TAX NO. ACCOUNT NO.
ENGINEER: PHONE
ADDRESS CITY/ST/ZIP
SITE ADDRESS: PARCEL NO. REQUIRED:
LEGAL DESCRIPTION:
DESCRIPTION OF WORK:
ESTIMATE COMPLETION DATE SOIL CLASSIFICATION ENG GEOL RPT BY
CY
AREA OF CLEARING SF MAX. EXISTING SLOPE
DISTURB VEG MAT YES NO MAX. FINISHED SLOPE
# OF TREES > 6" REMOVED SOIL RPT BY PROJECT
VALUE
NOTE:
1) This permit does not constitute approval or compliance with the rules, regulations, or requirements of any other jurisdiction, which may
relate to the above project.
2) Check with U.S. Army Corps of Engineers for possible permit requirements.
3) Permits are non-transferable.
4) WHERE MORE THAN 20 TREES WILL BE HAULED AWAY FROM THE SITE TWO (2) COPIES OF A HAUL ROUTE PLAN SHALL BE
SUBMITTED FOR APPROVAL PRIOR TO ISSUANCE OF THE LAND CLEARING PERMIT.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT AND THAT THE APPLICABLE CITY OF AUBURN
REQUIREMENTS WILL BE MET.
OWNER/AGENT: RECEIVED
BY
NAME TITLE
PRINT NAME:
DATE:
REF. H:AFORMS\FB013\3-95