Date:

-- mm/dd/yy

Please provide the following contact information:

Applicants Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail

Address where tree(s) are located:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Description of Tree #1:

Type of Tree#1:

Type#1

Diameter of Tree #1:

Diameter#1

Description of Tree#2:

Type of Tree#2:

Type#2

Diameter of Tree#2

Diameter#2

Description of Tree#3

Type of Tree#3

Type#3

Diameter of Tree#3

Diameter#3

Reason why applicant feels tree(s) should be removed:

Applicants proposal of replacement tree(s):

Any additional comments?