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Permit Number Date APPLICATION & PERMIT TO REMOVE A STREET TREE The undersigned hereby makes an application to remove a street tree. A report by a Certified Arborist as defined by Ordinance 2424 should attached to this application. SIGN & RETURN TO: ENGINEERING DIV., 190 GARFIELD ST., WOODBURN, OR 97071 LOCATION: REASON FOR REMOVAL: NAME OF APPLICANT: SIGNATURE OF APPLICANT: MAILING ADDRESS: CONTACT PHONE APPROVAL PERMIT APPROVED BY: Date The applicant agrees to abide by all standards, rules, regulations, ordinances, and policies of the City of Woodburn. This approved permit is valid for 180 days from date of issuance. There may be subsidy assistance available from the City for this tree removal. Following conditions apply: All stumps must be removed below ground level A replacement tree (minimum caliper of 2 inches) of a species that will reach approximate height of surrounding trees at maturity. Replacement tree may not be from prohibited list from the Woodburn Development Ordinance provided with this permit. Replacement tree shall be planted in accordance with attached Woodburn Street Tree Planting Regulations. DENIAL PERMIT DENIED BY: Date Denial based upon attached findings. The denial of this application may be appealed to the City of Woodburn Council within 10 days of the denial of the permit. The appeal should be in writing and sent to the City Administrator, City of Woodburn, 270 Montgomery Street, Woodburn, OR 97071. The City Council will hear and determine the appeal based upon information provided by the permit applicant and the Public Works Director.