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Chevy Chase Village
Statement of Appeal for Tree Removal Permit
Subject Property:
Briefly Describe the Proposed Tree Removal (provide additional detail on following pages):
Applicant Name(s) ( List all property owners):
Daytime telephone: Cell:
E-mail:
Address (if different from property address):
For Village staff use:
Date this form received:_____________________ Tree Removal Permit Appeal No:________________
Filing Requirements:
(Application will not be accepted or reviewed until the application is complete.)
Completed Chevy Chase Village Statement of Appeal for Tree Removal Permit (this form)
Denied Chevy Chase Village Tree Removal Permit Application
Chevy Chase Village Tree Inspection Report from Village Arborist
Surveys, plats, landscaping plans/specifications, or other accurate drawings showing
boundaries, dimensions, and area of the property, as well as the location and dimensions of all
structures/fences/walls/etc. and the tree(s) sought to be removed.
Appeal fee (See fee schedule in Chapter 6 of the Village Code).
Affidavit
I hereby certify that I have the authority to submit the foregoing appeal, that all owners of the property
have signed below, that I have read and understand all requirements and that I or an authorized
representative will appear at the scheduled public hearing in this matter. I hereby authorize the Village
Manager, or the Manager’s designee, the Board of Managers, and members of the Village Tree
Committee, to enter onto the subject property for the purposes of assessing the site in relation to this
appeal. I hereby declare and affirm, under penalty of perjury, that all matters and facts set forth in the
foregoing statement are true and correct to the best of my knowledge, information and belief.
Applicant’s Signature: ___________________________________ Date: _________________
Applicant’s Signature: ___________________________________ Date: _________________
