656 BAYWAY BLVD0
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CITY OF CLEARWATER - PLANNING & DEVELOPMENT SERVICES
TREE REMOVAL PERMIT
NAME OF OWNER.
SITE ADDRESS
PHONE
OWNER'S ADDRESS"
LOCATION OF TREE(S) ON LOT
SPECIES AND NUMBER OF TREE(S) 11-171g2WIf
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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
9 EASON FOR REMOVAL:
Construction
•See "A" below
U Hazardous
• Declining
• Dead
El Other (Specify)
removed is required. Fee Rec'd. $
° VJ Date i
A) CONSTRUCTION
1. For new construction, additions. or other modifications of a property which invo a 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: I
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 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 viglation of the Commu ity Development Code.
Signature of owner or appl cant Printed Name
Address Agency Representing OCL #
r-.+., state Zio Phone /Cell Fax
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Applicable Code Section r �'
Based on the Inspector's comments and Information submitted, the above removal application is:
a Approved as Submitted kAApproved- Modified as Noted Above a Denied
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Signed : Date: L��
Community evelopmrtCoord
in ator or Designee /Inspector Valid for six months from the date of issuance.
1362.0001 -GC White - Planning & Development Services Yellow - Applicant Rev. 2-03
d1A11�e i '
—_, SECTION 17, TWP. 29 . JRNG. 15 E. P.IN
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LEGAL DESCRIPTION W 24a 188;p
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LOTS 15, 16, 17 AND 18, BLOCK A, BAYSIDE SUBDIVISION NO. 5, \ \`P44
ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 38, PAGES (S) ! \ _ \'�
38 AND 39, PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA. .\
FIRM ZONE
THE ABOVE DESCRIBED PROPERTY APPEARS TO BE IN ZONE AE, IN q• ?
ACCORDANCE WITH THE FIRM MAP OF THE CITY OF CLEARWATER, FLORIDA,
COMMUNITY PANEL NO. 125096 - 0014 —D, MAP REVISED AUGUST 19, 1991.
PREPARED FOR WUNDARi 8 JR* Y
CERTIFICATI I N REBY CERiIfY TO ThE BEST OF MY KNOWLEDGE AND BELIEF JOB UM ER: 000061 DATE �t1RVEYED: t -26 -2000
CLEARWATER HOSPITALITY, INC. THAT THE vEY 9NM HNON SUBSTANTIALLY MEETS THE MINIMUM TECHNICAL DRA NG FILE: 00006t.DWG DATE DRAWN: t 26 -2 -2
STANDARDS LAND SUR*l WG DESOiIBEO IN THE STATE OF, FLORIDA RULE 61GI 1,
ASHWINI K. BAHL F.A.C. FURTH NORE, THIS CERTI OTION SHALL NOT EXTEND To ANY OTM Pf.RSC>NS LAS REV{SION: N/A X REFERENCE; 950224
JITINDER K. BAHL OR PARTIES C 00 THAN THOSE NAMED ON THIS SURVEY AND SHALL NOT BE
VAUD AND 8111DING AGAINST THE t1N0 9GNED SURVEYOR WTHDJT THE OWNAL GE GE A. SHW
CENTRAL BANK OF TAMPA, ITS SUCCESSORS AND /OR ASSIGNS RAISED sEU ND SIGNATUlf of THE FLORIDA UCENSED SURVEYOR AND MAPPER. AND S, 11VCOR oRATED
JOSEPH R. CIANFRONE, P.A. LAND SUf VEYt ?RS LAND Pb NNERS
ATTORNEYS TITLE INSURANCE FUND, INC. GEORGE IMP II, FL WIRED LAND SURVEYOR No. 2512
OwAYN A RUTH, SSIONAL SURVEYOR & MAPPER No. 5635 P.lLA/ Batt, FL N114 ,
THIS SURVEY I NOT COMPLETE OR VALID MM ATTACHED TO SURVEYOR'S REPORT. LB � 4 pffojvE' ( j Yd4 -51M Fes' (7P? i86 -J,256