301 CLEVELAND STCITY OF CLEARWATER - PLANNING & DEVELOPMENT SERVICES
99w �o� TREE REMOVAL PERMIT
NAME OF OWNER U IsVt o;C (, u0N,,)
SITE ADDRESS 3 of C �-'�,, r-� ►4TJr� S i
PHONE ,Ml. q ECO
OWNER'S ADDRESS 1 t' O __ S. 0 �✓E
T[QN ®:TT7EE; ON;L9T
r: SP�CIES-'AND Nl)M -IB'ER OF TREES) _LP <,Mki A- L,,4S•
A6 APPLICANT -A, on T'eT0r ,gable fee of $15.00 for up to five trees to
removed, plus $3,00 for every tree above 5 to be
removed is regUlred.
.Y.
I: �_
REASON FOR REMOVAL:
construction
•See "A" below
• Hazardous
• Declining
❑ Dead
❑ Other (Specify)
Fee Rec'd. S
Date �S 1 da 1
ew 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 1"=20' for single family lots, or 1 " =50' for all others. The
site plan must include:
a. Major Changes of Grade f. Proposed Number of Parking Spaces j. All Protected Trees Including:
b. Structure Locations g: Proposed. Underground Utilities (i.) Diameter of 4.5' above grade (DBH)
c, Driveways and Walks h: Zoning Setbacks (ii.) Surveyed Location
d. Parking Arrangement i. All easements and Rights -of -Way . (iii.) Species
e. Required Number of Parking Spaces (iv.) Diseased or Insect Infested Trees
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.
B) REPLACEMENTS
1. Tree replacement minimum standards: 10' overall height, 2.5" caliper, Florida Grade #1. See inspectors note below to.
determine the number of replacement trees required. Replacements required within 30 days.
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 together
with any pla c i hmitteri it n tri le representation of all facts Concerning th Nr^ —sed re—'al of the tree(s). Any dev iation
from the r d shall render it null and void and be considered a violation of the Community Development Code.
�cKu �So,J
Signa ure of owner or applicant Printed Na e
nn
Address Agency R presenting OCL #
4�-L 3119.42
City State Zip
DO NOT WRITE BELOW THIS LINE - Not Valid Until
Required Replacement Trees:
S7,Z• µboo
Phone /Cell Fax
ned By City MancLcler or his Resianated Aaent
Applicable Code Section:
Based on the Inspector's comments and information submitted, the above removal application is:
❑ Approved as Submitted Approved- Modified as Noted Above 0 Denied
Signed: — Date: ve
Community velopment C ordinator or Designee /Inspector Valid for si months from the date of issuance.
1362.0001 -GC White - Planning & Development Services Yellow - Applicant Rev. 2-03
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Serenoa repens Saw Palmetto 7 Gal., 60" O.C.
BAYFRONT BLUFF / OPUS
PLANTING PLAN
CONTRACT NO. N/A
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