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<br /> <br />IlL> -1,,-,) <br />./M !) ~D <br />J~r. <br /> <br />City of Zephyrh ills <br />5335 Eighth Street <br />Zephyrhills, Florida 33542 <br /> <br />TREE REMOVAL PERMIT APPLICATION <br />DATE: '~:/ '2 I ()tv Pre-App Mtg Date: <br />. <br /> <br />APPLICANT: ..:z Q L ., A 'v .\7 6 T E Y PHONE: (" /,) l;f'?' I.J.- 'I 1 <br /> <br />STREET: S71~-<: G..~(( '15iotf, CITY:,;ZI'[\'(d,:t(.l ZIP: J,M'fL <br /> <br />TREE'S) PROPOSED FOR REMOVAL <br /> <br />TREE TYPE: o Ci'k/p; !.At.- NUMBER: ( L DIAMETER: C;:!.. it'" d:l\....... (6. DBH & LARGER) <br />REASONFORREMO~AL: '~'..J~iJ;V.1 I",; rr-".f'.;.>4(,j O'\, .tl..,'.( .s;;k. <br />CONTRACTOR CONDUCTING THE WORK: :.:zeN", L.. (iI <. kJ (Cw --,,~ <br /> <br />SITE PLAN: Please provide diagram below identifying abutting streets, structures on the site and <br />location of trees to be removed: Property Appraiser's ID~)~:S ~>!G &, I r)") I C> ()Y I ~') aooo <br />SEC TWP RNG SUB BLK LOT <br /> <br />I Subdivision: <br /> <br />r. , <br />~~~, + ".( fr- <br />') <br /> <br />:", ph~{:J"'ilk. <br /> <br />JAMES w. CHILDERS <br />Notary Public, State of Florida <br />My comm. axp. Oct. 24, 2008 <br />Comm. No. DO 365283 <br /> <br />I hereby certify, affirm or swear that I am the owner or the authorized agent for the owner of the <br />property for which this permit is rej"~~. T1m~ftgf1ation provided herein is true and correct to the <br />best of my knowledge. I releamt~86~~lf16Waa all responsibility for damages incurred as a <br />result of the tree removal activi1My comm. expo Oct. 24, 2008 <br />Comm. No. DO 3652A3 <br /> <br />Swom to and subsaibed before me this <br />". ~ ~ay of ~~') 20~ <br /> <br />"-. <br />Notary Publi <br />(State of FI'cmcta rge :::><::::::> <br />My CommiSSio~'ExpIreS '~~-\\~:o.~~" NO REFUNDS <br />ISSUANCE OF THIS PERMIT IS SUBJECT TO THE FOllOWING: <br />The property owner will plant and nurture _ trees selected from attached appendix B of the Landscape <br />Code Ordinance 922_05. June 13,2005. within 30 days.m ~ <br />PERMIT APPROVED p' L) U'LA.; <br />DIRECTOR OF DEV OPMENT <br /> <br />PERMIT DISAPPROVED 0 C ~ ~ _ ~:'I c <,~ <br />ltt - J. <br /> <br /> <br />iii OWNER <br /> <br />o AUTHORIZED AGENT <br /> <br />Form/TreeRem 1105 <br />