ContractNovember 24th, 2014
FiledNovember 24th, 2014TREE MAINTENANCE/REMOVAL REQUESTPUBLIC WORKS DEPARTMENT / ENGINEERING DIVISION8130 Allison Avenue, La Mesa, CA 91942Phone: 619.667.1166 • Fax: 619.667.1380 REQUESTOR’S INFORMATIONDate: Name: Phone: Work Cell PhoneAddress: Contractor Performing Work: License #: Contact Name: Phone: Work Cell Phone Owner/Agent: / (Print Name) (Signature) REQUESTED ACTION (ONE TREE PER FORM) Remove Prune Root Prune Replace Other: (If Requesting removal are you willing to accept a replacement? Attach Tree Planting Request Form & Maintenance Agreement) Diameter (inches) @ breast height: (4.5 ft along tree centerline) Address/Location of Tree: Nearest Cross Street: Tree Species: Located within an easement: Yes No Unknown Encroachment Permit RequiredREASON FOR REQUEST Causing Damage Dead Uprooted/Safety Hazard Diseased Beautify Other/Description: Supplemental Data Attached: »»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»» FOR CITY USE ONLY «««««««««««««««««««««««««««««««« APPROVED ACTION Remove Prune Root Prune Replace O