APPLICATION PERMIT FOR

 

NON-PERMANENT PLACEMENT OF

 

PORTABLE STORAGE UNITS, PODS OR SIMILAR DEVICE

 

CITY OF CLARKSON VALLEY

15933 Clayton Road, Ste. 105

Clarkson Valley, MO 63011

 

Date __________________

 

 

Owner ____________________________________________  Phone ________________

 

Address _________________________________    Subdivision _____________________

 

Have Subdivision Trustees been notified?          Yes _____________    No _____________

 

 

 

            I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION GIVEN IS CORRECT, AND THAT I AM THE OWNER OR DULY AUTHORIZED TO ACT IN THE OWNER’S BEHALF AND HEREBY AGREE TO COMPLY WITH THE APPLICABLE REQUIREMENTS OF SECTION 215.010.18.b AND OF THE ORDINANCES OF THE CITY OF CLARKSON VALLEY, MISSOURI.  IT IS FURTHER UNDERSTOOD THAT THIS APPLICATION DOES NOT CONSTITTUTE A PERMIT.

 

 

 

Signed ___________________________________________________________________

 

 

Approved by ________________________________________ Date _________________

                        Building Commissioner

 

 

Fru-Con Center, 15933 Clayton Road, Ballwin, MO 63011 – City Hall - 636-227-8607