2577 HARN BLVDf VA A4
CITY OF CLEARWATER - FORESTRY DIVISION t 3 3 4 9
TREE REMOVAL APPLICATION FORM
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NAME OF OWNER: � ���► d' 1-�-- ee s �'D F 5
._�__�._ Rec.
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`` Date Rec: 7-/y-79
LOCATION OF WORK: 2 % % )+o r n 731 V c-1 _ Rec. By: F0
Clearwater, FL Rec't # c31 C-t g
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REQUIRED REPLACEMENT TREES }
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TREE REMOVAL PERMIT -
C' " 3.3 e ` -
NAME OF OWNER /42V r- r-A 1 t Gu 1�
OWNER'S ADDRESS 261 14
PHONE _2 3 Z
SITE ADDRESS 2 S -7 -7
LOCATION OF'TREE(S) ON LOT
SPECIES AND NUMBER OF TREE(S) -J L n,-S
TO APPLICANT: .A non - refundable fee of $15.00 for up to five trees to
be removed, plus $3.00 for every tree above 5 to be
removed is required.
REASON FOR REMOVAL-.
Q'Construction
❑ Hazardous
D Declining
❑ Dead
❑ Other (Specify)
Fee Recd. S
Receipt # ,.:! cici
Date -7 - 1 U- 1`i
1. For.new construction, additions or other modifications of a property which involve the removal of a protected tree(s),
a site plan is required. This site plan must have a minimum scale of V =20' for single family lots, or 1' =50' for all others: The
site playa must include:
.a. Major Changes of Grade i.
All easements and Rights -of -Way
b. Structure Locations j,
All Protected Trees Including:
c, Driveways and Walks ��., fC_
(i.) Diameter of 4.5' above grade (DBH)
d. Parking Arrangement
(ii.) Surveyed Location
e. Required Number of Parking Spaces
(iii.) Species
f. Proposed Number of Parking Spaces !
(iv.) Diseased or insect Infested Trees
g. Proposed Underground Utilities
(v.) Trees to be Removed
h. Zoning Setbacks ; k.
Tree Barricade Detail & Locations
2. Protective barriers are required around all trees remaining on site during construction. These barricades must remain
Intact during construction. The barriers must meet City Specifications,
3. Tree replacement minimum standards: 8' overall height, 2' caliper, Florida Grade #1. See inspectors note below to
determine the number of replacement trees required.
I hereby certify that as property owner or as representative of the property owner, I have verified that the tree(s) sought
to be removed is wholly on property owned by the above - Identified property owner, and should it be determined that
the tree(s) are located wholly or partially on property owned by some other person; then, I agree to hold the City of
Clearwater harmless in any claim made for wrongful removal of such tree(s). I hereby certify that this application to-
gether with any plans submitted Is a true representation of all facts concerning the proposed removal of the tree(s). Any
deviation from the permit issued shall render It null and void and be considered a violation of Chapter 52, Code of
Ordinan s.
/Da _-
Signature of owner or applicUM Printed Name l
�Oi� S'h -e L0 I
Agency Representing (If Not Owner)
%? /3- -) Sa --- y// rj
Phone
Address �-
s0 /,�f,T
City State Zip
DO NOT WRITE BELOW THIS LINE - Not Valid Until Signed By City Manager or his Designated Agent
Recommended Replacement Trees:
uired Replacement Trees:
Applicable Code Section:
Signed: `"" "� �"" ' �°' Date I q
I n.4ector
Based on the Inspector's commis and information usjr.nifted, the above removal application is:
❑ Approved as Submitted (Approved= Modified as Noted Above ❑ Denied
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Signed: z `-� �--- Date: -7 q
Ci Manager or Designee
CLEARWATER
:- One Citjc One Future.
14k 1, Rita Garvey, Mayor- Commissioner
Ed Hooper, vice Mayor- Commissioner - Bob Clark, Commissioner
1362,0001 -(k J.B. Johnson, Jr., Commissioner Karen Seel, Commissioner 10 -97
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