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S «` CITY OF CLEARWATER - PLANNING & DEVELOPMENT SERVICES Jam'
TREE REMOVAL PERMIT
NAME OF OWNER 11 , C. , 17
SITE ADDRESS 110 t-3 F70 r.fr
PHONE 12_ 1 - y l9 - 9.4 2
OWNER'S ADDRESS I I Zb M.
LOCATION OF TREE(S) ON LOT
SPECIES AND NUMBER OF TREE(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:
'Construction
•See "A" below
• Hazardous
• Declining
• Dead
• Other (Specify)
ree Kec'a.
A) CONSTRUCTION
Date 0 ,.4
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 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 (L) 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: l0' 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 plans submitted is a true representation of all facts concerning the proposed removal of the tree(s). Any deviation
froM the permit issued sh II render it null and void and be considered a violation of the Community Development Code.
GC'2AOi'u �7t'2�iVl
Signatur&z0owner or applicant Printed Nabe
Z I Zo Die � �-. OMAN C xy4.
Address / Agency Representing OCL #
Geia,.r��,4ear FL 33 -7(,5 (7z-? ` gZ- 3) I_-7
City State Zip hone /Cell Fax
DO NOT WRITE BELOW THIS LINE - Not Valid Until Signed By City Manager or his Desianated Aaent
Applicable Code Section: , - JZ0
Based on the Inspector's comments and Information submitted, the above removal application is:
O Approved as Submitted Approved- Modified as Noted Above ❑ Denied
Signed: UL�� Date:
Community D velopment ordinator or Designee /Inspector Valid for six months from the date of issuance.
1362.0001 -GC White - Planning & Development Services Yellow - Applicant Rev. 2-03
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MAP NO. 12103CO106G, COMMUNITY PANEL NO.12509,f,
0106 G, EFFECTIVE DATE 9/3/03, NATIONAL i•1f
NOTE: INSURANCE MANAGEMENT AGENCY.
TO CONVERT SURVEY DATUM TO NGVD 29, SUBTRACT
60.67 FROM ' i
CONTRACTOR NOTE:
ALL EXISTING ON SITE UTLITIES Trr BE ABANDONED,
OR RELOCATED. ABANDONED O r BE TERMINATED
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(19 L L FOR PE5CRIFTION5
EXISTIN& TREE TO BE
REMOVEP, SEE L-3 ANP L-4
FOR PE5rKIFTIONS
ALL tANIDSCAPING TO BE PROTECTED
FROM VEHICUA OR PEDESTRIAN
TRAFFIC BY A MINIMUM SIX INCH
HIGH CURBING AND WHEEL STOPS
."Vy CHANGES W SPECIES,
SPECIFJC-;,\TiC)N S, OR DLSIGN
WITHOUT THE CONSENT OF THE
PL,-',NlN)NG DIRECTOR C�EEND70c
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