MARIPOSA COUNTY
RESOURCE CONSERVATION DISTRICT
5039 Fairgrounds Rd
P.O. Box 746, Mariposa, CA 95338
(209) 966-3431 x103
[email protected]
Hazard Tree Removal Assistance
Program Application
The Mariposa County Resource Conservation District (MCRCD) has a new program to assist
residents in need of financial support to remove hazardous dead trees that threaten their homes.
Assistance is intended to first serve low income households who are unable to afford the cost of
removing hazardous trees with their own resources. Assistance will be provided to moderate income
residents if there are funds remaining. Dead and dying trees within 100 feet of structures or
threatening access to or exit from the property will be removed, and waste chipped and left at the site
or disposed of.
Applications must be completed in full, and will be accepted on a first-come, first-served basis. Tree
removal and wood waste disposal services will be performed based on availability of funding.
Scheduling will be determined by when work is being undertaken in your community. Applications
must be accompanied by photographs. A site visit to mark and assess trees will also be conducted.
Once all required documents have been received, you will be contacted and advised of your
application status.
Program Requirements
1. Applicants must provide verification that they are enrolled in a qualified income assistance
program.
2. If not enrolled in a program, applicants must provide the signed page of a current tax return
showing adjusted gross income (Line 38 on Form 1040).
3. Work must be performed at the site of a primary residence.
4. Applicants must sign a Right of Entry permission form.
5. Applicants must sign a Release of Information form.
6. Photographs of trees to be removed must be provided with application.
7. Applicants must provide proof of identity (photo ID or other verifiable ID).
Please complete the attached application and certification forms, provide photos and proof of
enrollment in an income assistance program or tax return page. Applications may be submitted by
mail, in person, or via email to:
MCRCD Hazard Tree Removal Assistance Program
PO Box 746
5039 Fairgrounds Rd
Mariposa, CA 95338
[email protected]
For questions, please contact Nicole Poor, Office Manager, at (209)966-3431 Ext. 103.
Hazard Tree Removal Application
_____________________________________________________
Name ____________________________________Parcel Number_______________
Street Address ________________________________________________________
Mailing Address _______________________________________________________
Community Name ___________________________Property Size (acres) __________
Phone ____________________ Email _____________________________________
Are you the property owner?  Yes  No
Primary Residence?  Yes
 No
How many trees for removal are within 100 ft of the residence? _______________
How many trees are: Ponderosa Pine __________ Oak ___________ Other _______
How do you want to handle lumber:
Left on site in 4’ – 6’ lengths _____________ Removed ______________________
How do you want to handle slash:
Chipped and left on site__________________ Removed _____________________
Please provide photographs of the trees that need to be removed (hard copy or digital).
Special instructions for tree removal – are there fences, specimen plants or other features that require
special care during tree removal? We will do our best to accommodate but cannot guarantee
results.______________________________________________________________________
____________________________________________________________________________
Proof of enrollment in one of the following programs qualifies you for free tree removal:
Social Security Disability Insurance (SSDI)
PG&E CARE program
Senior Fire Wood Distribution Program
Senior Supplemental Food Program
Lifeline Telephone Program
Medi-Cal
Veteran’s benefits
Reduced or Free School Lunch Program
Lifeline Telephone Program
Other
You may also qualify for tree removal based on the Adjusted Gross Income reported on your Federal
income tax documents. Please provide a signed copy of the second page of a recent tax return.
I certify that the above information is correct and that I understand that the information is subject to
verification.
Signature ____________________________________ Date___________________
Received by __________________________________ Date___________________
Hazard Tree Removal Application
___________________________________________________
Authorization to Release Information
I, _____________________________________________, authorize the Mariposa County
Name of applicant
Resource Conservation District (MCRCD) to disclose to CAL FIRE
(Check all pertinent items)
 Personal information such as name, address, phone number, parcel number, etc.
 Income eligibility information
This information is required for MCRCD to satisfy the requirements of the grant received from CAL
FIRE, as well as Licensed Tree Contractors and Foresters to ensure that participants receive
appropriate tree removal services within the grant guidelines.
I may revoke this authorization at any time before the information has been released. In any case,
the authorization expires two years from the signature date below.
Please check this box if you would like a copy of this authorization

The following information is needed to ensure accurate identification and eligibility:
____________________________________
Applicant Name (Please print)
____________________
Date of Birth
_____________________________________
Applicant Signature
_____________________
Date of Authorization
MARIPOSA COUNTY
RESOURCE CONSERVATION DISTRICT
5039 Fairgrounds Rd
P.O. Box 746, Mariposa, CA 95338
(209) 966-3431
[email protected]
Hazard Tree Removal Program Right of Entry
Your signature on this form serves as authorization and permission for contractor crews to enter your property
and perform Hazard Tree Removal as described in your application, using the descriptions below. Tree work
will be performed by an MCRCD contractor and will involve cutting and processing of trees that pose a threat
to health and safety. The contractor will complete this form onsite and provide you with a copy.
Initial Check
_____

_____

_____

DBH
Species
Quantity
Wood and Chips onsite. Trunk of tree(s) will be cut down ____ ____________________ ______
as low to as safely possible. Wood larger than 4” in
diameter will be left on site in lengths between 4” and 8”.
Wood less than 4” in diameter will be chipped and left onsite.
Stumps will not be removed.
All Wood Removed. Trunk of tree(s) will be cut down as low _____ ____________________ _____
to as safely possible. All wood will be removed.
Stumps will not be removed.
Wood Removed, Chips Onsite. Trunk of tree(s) will be cut
down as low to ground as safely possible. Wood larger
than 4” in diameter will be removed. Wood less than 4” in
diameter will be chipped and left onsite.
Stumps will not be removed.
_____ ________________ _______
Special Instructions (dogs on site, structures or specimen plants needing protection):
______________________________________________________________________
______________________________________________________________________
Please sign and date this form. The contractor will work with you to complete the section above when
scheduling work. You will receive a copy once the form is complete.
______________________________________________
Signature
Print Name
Property Address
______________________
Date
Phone
(
)
Community Name
Parcel Number
Prepared by (Contractor)
Date of Tree Removal