APPLICATION PERMIT FOR

NON-PERMANENT PLACEMENT OF

PORTABLE STORAGE UNITS, PODS OR SIMILAR DEVICE

CITY OF CLARKSON VALLEY

15933 Clayton Road

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