CITY O
OO
GW D
OLLI N
FR
OFFICE USE ONLY
Permit Number:
File Date:
CITY OF ROLLINGWOOD
403 NIXON DRIVE
ROLLINGWOOD, TEXAS 78746
512-327-1838
TREE MAINTENANCE PERMIT APPLICATION
* A photocopy of the applicant’s driver’s license is required
Name of Applicant:_____________________________________________
Address:_____________________________________________________
Phone Number: _______________________________________________
If applicant is an association, partnership, corporation, or company, please indicate below the
name of the entity:
____________________________________________________________
Please indicate below the names of the persons who will be performing tree maintenance within
the City of Rollingwood:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Revised: August 21, 2014
Please indicate below the names of other communities in which the applicant has performed
tree maintenance within the last twelve months
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
If employed by a different company in other communities within the previous twelve months,
please indicate the name of those companies:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Please indicate below any certifications the applicant and his/her employees may possess
related to tree maintenance:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
I, _______________________________________________, do hereby acknowledge by my
signature below that I have received and reviewed the City of Rollingwood Oak Wilt Ordinance.
________________________________________________
Applicant Signature
________________________________________________
Print Name of Applicant
Revised: August 21, 2014