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1212 BETTY LN NCITY OF CLEARWATER a PLANNING & DEVELOPMENT SERVICES ,.L a TREE REMOVAL PERMIT 0 99'�ATEAE�o� . {'i NAME OF OWNER fyQ�e Le- OWNER'S ADDRESS l a Ja /U PHONE YZ gr- �:�'�� C2 SITE ADDRESS LOCATION OF TREE(S) ON LOT — SPECIES AND NUMBER OF TREE(S) _.I TO APPLICANT: A non - refundable fee of $15,00 for LID to five trees to be removed, plus $3.00 for every tr removed is required. V El " E ur" REASON FOR REMOVAL: XConstruction • Permit # v See "A" below • Hazardous • Declining • Dead • Other (Specify) Fee Rec'd. $ SEP Receipt # A) CONSTRUCTION 4 ZQD3 Date 1. For new construction, additions or other modificatioflL �� ' e removal of a protected tree(s), a site plan is required. This site plan must have a minimum scale q r�`�ily lots, or 1 " =50' for all others. The site plan must include: CITY OF CLEARWATW�R a. Major Changes of Grade f. Proposed Number of Parking Spaces J. �f1 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 L 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. Z O B) REPLACEMENTS V " 1. Tree replacement minimum standards: 12' overall height, 4" 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 plans submitted is a true representation of all facts concerning the proposed removal of the tree(s). Any deviation from the permit is ued sticill re er't null and void and be considered a violation of the Communi Development Code. 7 e ar 40 atur4 of ner r I cant Printed Name 9 "i ( IVO/' AaJlYd►�r� @rt C.ON.$!rLtC /! M C.r�• Cjj lc o.2 90 A-"ddre'ss Agency Representing OCL # /M ,�&,- o rlcicx 3 &-3-- ZZ 7 78rtK- 6.3 ZR 9 —3 �e2R City State , Zip Phone Fax DO NOT WRITE BELOW THIS LINE - Not Valid Until Signed By City Marr or his Designated Agent Required Replacement Trees: Applicable Code Section::'" j ©13— Based on the Inspector's comments and information submitted, the above removal application is: 0 Approved as bmitted kApproved-Modified as Noted Abo e - 0 Denied Signed: Date: Communi Developm nt Coordinator or Designee /Inspector Valid for six months from the date of issuance. 1362.0001 -GC White - Planning & Development Services Yellow - Applicant Rev. 4 -01 _..�_ - -_..._ . __. -- �u _. ^_._- �� �/2° - G C i[Z ®� �x,�-��pL, i . ; z urung: u atlas# 269B I FOUNIO sxg - IR -L--] Q,O,o 0 MO R CA5 1) 9. 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