3826 AMHERST ST. WEST UNIVERSITY PLACE, TX 77005 | 713.662.5833 | INSPECTIONS@WESTUTX.GOV
PAGE 1 OF 1
Public Works Department
Development Services
INSPECTION REQUEST LINE 713.662.5805 | BEFORE 4:30 PM FOR NEXT DAY
BUILDING–LOW IMPACT EXCEPTION
APPLICATION
CONTRACTOR INFORMATION
CONTRACTOR FIRST NAME LAST NAME
COMPANY NAME
PERMIT NUMBER
CONTRACTOR ADDRESS
PHONE NUMBER EMAIL
CONTACT PERSON INFORMATION
CONTACT PERSON FIRST NAME LAST NAME
PHONE NUMBER EMAIL
PROJECT INFORMATION
PROJECT ADDRESS
TYPE OF WORK
The work to be completed on said property will not damage
any large trees (+19 inches circumference) or any large trees
on adjoining property.
Attach the site plan for the proposed work.
I understand that any information submitted in error will
result in plans being returned and the possibility of my
permit being revoked.
SIGNATURE DATE
PRINT NAME
TITLE
DEFINITIONS
Large Trees
Means any tree with circumference of 19 inches or more.
In case a tree is removed, it is presumed to have been a Large
Tree if the diameter of the stump is six (6) inches or greater,
measured in any direction.
Damage or Damaged
To "damage" a Tree means to take any action which could result
in a Tree's death, either immediately or after a reasonable period.
Some examples of such action, which are not intended to limit
this denition, are as follows:
severing the main trunk or large branches or large roots,
girdling, poisoning, carving, mutilating, touching with live wires,
piercing with nails or spikes, crushing or exposing the roots,
digging or drilling any hole larger than three cubic feet (or a
trench) within the Critical Root Zone, covering a substantial part
of the Critical Root Zone or compacting a substantial part of the
soil in the Critical Root Zone.
NOTE: MUST PROVIDE 2 COPIES OF THE PROPOSED SITE
PLAN WITH ALL TREES ON THE PROPERTY.
MUST NOT BE ANY LARGER THAN 11"X17"
OFFICE USE ONLY
FEE DATE
$
INSPECTOR INSPECTION DATE
COMMENTS
LOW IMPACT EXCEPTION
