Modified 04/27/2017
Borough of Wilkinsburg
Code Enforcement
Municipal Building
605 Ross Avenue
Wilkinsburg, PA 15221
Phone: (412) 244-2923 Fax: (412) 244-2922
ARBOR (Tree) WORK PERMIT APPLICATION
In accordance with Chapter 241 in Borough Code of Ordinances
Application Date_______________________ Permit #____________________
Name of Applicant _____________________________________ Phone #______________________________
Address of Applicant _____________________________________ Email_______________________________
City, State, Zip __________________________________________ Lot & Block __________________________
Owner Name _________________________________________ Phone # _____________________________
Owner Address _________________________________________ Email_______________________________
City_________________________________________________ State ______________ Zip _______________
Location of Tree________________________________________ Species of Tree_______________________
PA ONE CALL NUMBER_______________________________________________________________________
Nature of work (include everything to be done to the tree, including and disturbance to roots larger than 2
inches in diameter):__________________________________________________________________________
Person/Firm performing work: ________________________________________________________________
Attach copy of Certificate of Insurance with Borough as certificate holder. Removal of large trees or thinning
or reduction of the crowns of large trees must be carried out by a properly insured contractor
In signing below, the applicant (or his/her agent) agrees that the work will be carried out in accordance with
the “Rules and Regulations for Arbor Work,” which has been adopted by the Department as standard practice.
A copy of the “Rules and Regulations for Arbor Work” is to be provided to the applicant at no additional
charge.
Signature of applicant _____________________________________ Date____________________
Approved with the following conditions:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Approved by: ____________________________________ Date_________________
Fee $50.00
A copy of this application/permit is to be given to the applicant
