RT05 - 1125 State StFILED
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MARGIN ABOVE RESERVED FOR RECORDING INFORMATION
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DATE OF INSTRUMENT: 10 18 , 20 J3
RETURN ADDRESS: City of Blair
218 S. 16t' St.
Blair, NE 68008
CITY OF BLAIR - RIGHT OF WAY TREE PERMIT
Permit'00
Date: to -- I S --(3
Additional Description of project if necessary:
PROJECT INFORMATION:
Job Address: 112-5�
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Approximate Completion Date: 12-1-13 Fee: $15.00
Site Plan Drawing Attached: 4 - , " Type ofTree: 0hK111W&,Q1C-
TYPE OF ALLOWABLE TREES TO BE PLANTED ON CITY OF BLAIR RIGHT OF
WAY:
1. Street trees are herein defined as trees, shrubs, bushes, and all other woody vegetation on
Municipal right -of -ways, on all streets, avenues, boulevards, alleys, or other transportation
ways within the Municipality.
2. Park trees are herein defined as trees, shrubs, bushes and all other woody vegetation in
public parks and all other public lands owned by the Municipality.
3. Small trees are defined as Crab Apple (small or no fruit only), Golden Rain Tree, Hawthorne
(by special permission only), Hop Hornbean, Japanese Tree Lilac, Maple as follows: Amur
Maple, Compectre or Hedge Maple, Tartarian Maple, Callery Pear in variety, and Redbud.
4. Medium trees are defined as Amur Cork Tree, Birch as follows: Monarch Birch, Canoe
birch, River Birch; Buckeye as follows: Ohio or Yellow; Ginkgo, Linden as follows:
Littleleaf and Edmond; Oak as follows: Bur, English, Sawtooth, Shingle, Swamp White,
Pagoda Tree, Yellow Wood.
5. Large trees are defined as Hackberry, Honeylocust (thornless and padles only), Horse
Chestnut, Kentucky CoffeeTree, Maple as follows: Black and Sugar; Oak as follows: Black,
Red, Scarlet, White.
We, understand as the owner of the property, that we, our heirs or our assignees are
responsible for the perpetual care, maintenance and removal of said tree(s), and we agree to
not plant any tree(s) closer than ten (10) feet to a curb or fifteen (15) feet from the shoulder of
the road if there is no curb. We also agree not to plant any tree(s) within six (6) feet of any
public sidewalk, and all trees) planted will be in conformance with Section 6 -319 of the Blair
Municipal Code.
,ignature Owner s
STATE OF NEBRASKA )
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WASHINGTON COUNTY )
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Date
The foregoing instrument was acknowledged before me on OL+b �, 20 D , by
1 i , owner(s) of the above stated real property.
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Date Permit Paid: Receipt # Approved by:
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