1444 - 1494 BELCHER RD STREE REMOVAL APPLICATIO FORM N19 08887
NAME OF OWNER: �..Ok�IV Fee Rec. $
Date Rec:
LOCATION OF WORK: I46o 39WZ.15 H61_1 R b • Rec. By: • .r_ _ #
Clearwater, FI. Z MK:Z.IJN_ PLA24•- Rec 't #
REQUIRED REPLACEMENT TREES
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PERMIT TO REMOVE TREE (S) \
NAME OF OWNER �" � • LZ ��� � •�
OWNER'S ADDRESS f1�S 90Y. V 16J ,gyp
PHONE 445' / f %Z 1.�.��' 3S"� u/ %
°i 06887
REASON FOR REMOVAL:
❑ Construction
❑ Hazardous
❑ Dead - Dying
❑ Other - (Specify)
Fee Rec: $
Rec't. # 2"g'��—
PLEASE READ AND SIGN:
1. On New construction, additions, or other moditications of a property which requires°th removal or relocation of a protected tree(s) (Larger
than 4" in diameter at 4Ys ft. above grade); a Sits Plan is required 1Nhen removal is7equestedljor construction purposes, the Site Plan must
have a minimum scale of 1 ":0' for singe family lots or ,1 "30 ,for. multi- farmly` commercial or industrial sites. The Site Plan must show:
1. Major Changes of Grade 9 ,All, Easements and Rights tiflNay
2. Structure Locations f0 `AII Protected Tree§ `inciuding:
3. Driveways and Walks A .Diameter (DBM)yat 41 /i ft above grade
4. Parking Arrangement (if any)_ re :' t Bs t ocation (Su yed)
5. Required Number of Parking Spaces h C., Species {
6. Proposed Number of Parking Spaces' f D .Any Diseased, Inseot Infested Trees
7. Underground Utilities to be installed h E Designate Trees Requested to be. Removed
8. All Setbacks per Zoning ti
2. Protective Barriers are required around all-trees remaining on. site during construction These >barncades must, remain intact during construe
tion as a citation will result if they do not remairistanding and #unetional Protective Barriers mustmeet -Cdy Specifications per City Ordinance.
01
3. The replacement (Planting) of trees (Minimum Ht of 6) maybe required on your property before occupancy is allowed. Trees are to be selected
from the approved list on file m'the Enwronmental Division. See inspectors:note belotry to defermine the number of trees required when the
approved permit is returned to you s ` ,
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I hereby certifiy that as property owner or as representative of the prdpery owner -�I ho verrf�ed;that the'tree(s) sought to be removed is wholly
on property owned by the above identified propetty owner,. and should'd appear to ba, letermined that:tfte tree(s) are located wholly or partially
on property owned by some other.person,:then Lagree to ho "►d the City of Clearwateraiarmless'in any.c(aim made for wrongful removal of such
tree(s). I hereby certify that this applicationtogether.with any plans submitted is a true representation of alt facts concerning the proposed removal
of iA ree(s). Any dey' tion fr rt the perniitissued sliali tender it null and void :and be considered-146 vitaUon:of Ordinance 1623, Section 23A,
C d 1 of Ordinanc
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Signature of A licant if not owner Printed- Nam
Agency Representing & Phone Signature of Owner
14 G# Date Received
Address Called /Mailed
PICKED UP
City State REQUIRED;: REPLACEMENTS
DO NOT WRITE BELOW THIS LINE — Not Valid Until Signed By City Manager or his Designated Agent
gequired Replacement Trees 12 t / rr [+ice 4-J fi= KJ ;✓z
Signed Date r 0 C` c l , L
Inspectdr �� —
Based on the Inspector's comments and information submitted, the above removal application is:
❑ ApRroved As ubmitted /Approved — Modified As Noted Above ❑C Denied
Signed: \ Date: ► T ^`
City Manager 6r Designee
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