401 BELCHER RD SSEA`•, CITY OF CLEARW
ATER - PLANNING & DEVELOPMENT SERVICES
9qo� TREE REMOVAL PERMIT
�AiEA.E
NO.
NAME OF OWNER u A.1-A %JS-7 REASON FOR REMOVAL:
OWNER'S ADDRESS )a- Go 6, L =� ���. 04 Construction
3 � -�, 5� AL-�- �377'� •Permit # T3c-P �c�c) � ;6t
PHONE -
See "A" below
SITE ADDRESS �v t S.. ��z�.� -r � a • ❑Hazardous
LOCATION OF TREE(S) ON LOT Parties.4 4) s w e.:,rever 'c) �' Lc,- !-+ttt
SPECIES AND NUMB OF TREE(S)0 Declining
❑ Dead
.i
�aZ 6, 6 V�-1 IQU� 6 0 E G/ ❑ Other (Specify)
TO APPLICANT: A non - refundable fee of $15.00 for up to five trees to
be removed, plus $3.00 for every tree above 5 to be
removed is required. Fee Recd.$
Receipt
A) CONSTRUCTION Date
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 (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: 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
fr the permit issued shpIll render it null and void and be considered a violation of the Community Development Code.
Signature of owneQr or appl ant , Printed Name
t n n. pit tJ- VoCr, e."
Lis 9 f!,— _4 O . ��`J 5 1P 2;
Address Agency Representing (If Not Owner)
-y_-7 3,4 -1 5`3'3 3 '7 3 -)
City State Zip Phone Fax
DO NOT WRITE BELOW THIS LINE - Not Valid Until Signed &, City Mgylager or his Designated Agent
Applicable Code Section: _ f Z-Q
Based on the Inspector's comments and information submitted, the above removal application is:
0 Approved as Submitted Approved- Modified as Noted Above 0 Denied
Signed: Date:
Community De elopment Coordinator or Designee /Inspector r
1362.0001 -GC White - Planning & Development Services Yellow - Applicant Rev. 11-00
Water Meter Connection
- ----------
nw
Ford Angle al
Valve (Typ.)
Cleanousit Rug
Cancrete Pad 4"
C, L-E A N 10 U T
MT.S.
DETAIL
NOTE: Cleanout plug to be
U.S. Foundry 7621
or equaL
9 7/9'
131/7
CLEANOUT --PLUG D ETAI L
N.T.S.
0
III VIII � 1
A APPROVED DOUBLE-0-11SCK VALVES
Hersoy13eeco Model FDC
Watts Model 709 or 007
Conbraco 40100
PA
2" GAT__ VALVE WITH BOX
2" REDUCED PRESSURI
BACKFLOW PREVENTER
'" POTABLE METER
2"x2"x2" TEE
(5
CL
D ETAI L
N.T.S.
I
2" GATE VALVE WITH BOX
1" REDUCED PRESSURE
BACKFLOW PREVENTER
1" IRRIGATION MIETER
2" GATE VALVE WITH 13OX
alm-m
16*1fTio♦ 1m; m_t1*,m9;T*z1U19
stainless steel straps
with epoxy coated
ductile iron body.
X
SERVICE
Water Service Tubing
Driscopipe 5100 or EndotfYardley
Blue Jet, SDR 9,3408 Polyethylene
CONNECTION
N.M&
1. THE CONTRACTOR OR SUBCONTRACTOR SHALL LAY WATER LINE AND
SERVICES A MINIMUM OF 3'-U'FROM THE FINISHED GRADE TO THE TOP OF
CF THE PIPE.
DETAILNOT VALID UNLESS SIGNED & SEALED SY:
GERALD P. GOULISH
FLORIDA PROFESSIONAL ENGINEER No. 21,340
48 HOURS
BEFORE YOU D G
'"CALL SUNSHINE"
1-800-432-4770
w
-MEL4LEUCZ4 7REE
-OAK 7RF-E
0
-PALM TREE
',,
-PINE TREEE
0
-SEA GRAPE 7REE
25?'T
-SHRUSS
Cleanousit Rug
Cancrete Pad 4"
C, L-E A N 10 U T
MT.S.
DETAIL
NOTE: Cleanout plug to be
U.S. Foundry 7621
or equaL
9 7/9'
131/7
CLEANOUT --PLUG D ETAI L
N.T.S.
0
III VIII � 1
A APPROVED DOUBLE-0-11SCK VALVES
Hersoy13eeco Model FDC
Watts Model 709 or 007
Conbraco 40100
PA
2" GAT__ VALVE WITH BOX
2" REDUCED PRESSURI
BACKFLOW PREVENTER
'" POTABLE METER
2"x2"x2" TEE
(5
CL
D ETAI L
N.T.S.
I
2" GATE VALVE WITH BOX
1" REDUCED PRESSURE
BACKFLOW PREVENTER
1" IRRIGATION MIETER
2" GATE VALVE WITH 13OX
alm-m
16*1fTio♦ 1m; m_t1*,m9;T*z1U19
stainless steel straps
with epoxy coated
ductile iron body.
X
SERVICE
Water Service Tubing
Driscopipe 5100 or EndotfYardley
Blue Jet, SDR 9,3408 Polyethylene
CONNECTION
N.M&
1. THE CONTRACTOR OR SUBCONTRACTOR SHALL LAY WATER LINE AND
SERVICES A MINIMUM OF 3'-U'FROM THE FINISHED GRADE TO THE TOP OF
CF THE PIPE.
DETAILNOT VALID UNLESS SIGNED & SEALED SY:
GERALD P. GOULISH
FLORIDA PROFESSIONAL ENGINEER No. 21,340
48 HOURS
BEFORE YOU D G
'"CALL SUNSHINE"
1-800-432-4770
w
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