City of Bridgeport, CT Department of Parks and Recreation Bill Finch, Mayor Charles Carroll, Director of Public Facilities Board

of Park Commissioners

ADOPT-A-TREE COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

CONTACT INFORMATION 1. CONTACT NAME:__________________________________Phone: __________________ Cell phone:_____________ADDRESS:_____________________________________________ Zip Code:____________Email:___________________________________________________ PROPERTY OWNER INFORMATION 2. Property Address: _____________________________________Zip Code:____________ 3. Property Owner Name: _____________________________________________________ 4. Phone: ________________________ Email: ______________________________________ 5. Property Owner Name & Mailing Address (If different from above): ____________________________________________________________Zip Code: ________________ 6. Please list the full name of all the property owners on the deed: ______________________________________________________________________________________ SITE LOCATION INFORMATION 7. Please describe the planting location you are requesting: ______Street ____Front Yard 8. Do you know where pipes, utilities or sewer lines may be located at this residence? Yes____No_____ Please describe:__________________________________________________
(Call-Before-You-Dig will be called before planting to mark site for underground utilities)

Request to Plant Form

PROPERTY OWNER MUST INITIAL AND SIGN BELOW: ___________ I have read and understand the terms and conditions described in Agreement to Adopt-A-Tree (the document attached to this form). ___________ ___________ I agree to adopt and care for the requested tree. I understand that heavy equipment may be used to prepare the soil for planting a tree either in the right of way or in the front yard.

Under Section 23-60 of the General Statutes of the State of Connecticut, the City is authorized to plant trees on private property with the written consent of the property owner.
I hold harmless the City of Bridgeport and I fully understand, will abide by and cooperate with the Rules, Regulations and Policies of the Parks and Recreation Department. I hereby release the City of Bridgeport, the Bridgeport Parks and Recreation Department, their officials, directors, supervisors, employees, volunteers, and sponsors from any liability as a participant in Bridgeport Community Development Block Grant Tree Planting Program. My consent allows the Parks and Recreation Department employees, City officials and workers permission to enter upon the land, execute all digging, shoveling and preparation work on the property, in accordance with this application and upon terms agreed to by all parties, the City and the Adopt-A-Tree recipient(s), when needed. I also understand it is my sole responsibility to maintain and nurture the tree to healthy growth following the planting. Failure to do this to the best of my ability, or the removal and relocation of a tree awarded and planted at a specified address, will result in dismissal from this program.

SIGNATURE:______________________________________________DATE___________________________
Please contact Steve Hladun @203-576-7797 or Steve.Hladun@bridgeportct.gov with any for information. City of Bridgeport, Parks and Recreation Department. 7 Trumbull Rd, Trumbull, CT, 06611

OFFICE USE: Reviewed by: _______

Section: ______

REQUEST No._______

City of Bridgeport, CT Department of Parks and Recreation Bill Finch, Mayor Charles Carroll, Director of Public Facilities Board of Park Commissioners

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

The Department of Public Facilities, Parks and Recreation Department would like to provide trees for your street. THANK YOU for stepping forward to participate in this initiative in the effort to maintain and enhance the Citys tree population. Adopt-A-Tree Applications are available online and at the Bridgeport Parks and Recreation Office, 7 Trumbull Road, Trumbull, CT 06611. This program has been made possible by the U.S. Department of Housing and Urban Development and Community Development Block Grant Program, the American Recovery and Reinvestment Act and the City of Bridgeport. Street Tree Planting requires planning, preparation and stewardship. The commitment to adopt a tree as part of this agreement is a significant undertaking; it demonstrates your willingness to provide care and water to the tree; to contribute to the greening of Bridgeport and to the improvement of the landscape in your local community.

AGREEMENT to ADOPT-A-TREE

Adopt-A-Tree Community Development Block Grant Tree Planting Program Guidelines:

PLANTING LOCATION Parks and Recreation Department staff must meet with the applicant to determine the placement of the tree. Locations with adequate root space and accessibility for equipment are required. Areas in the right of way or in the front yard must be away from utilities, vehicular and pedestrian traffic. TREE CARE Trees must be planted and cared for to acceptable arboricultural standards. Adopt-A-Tree applicant agrees to care for the tree; water the tree at least twice a week and to monitor the trees condition and health. TYPES OF TREES The kind of trees planted will be governed by site conditions, but will be one generally accepted as a good street tree for Connecticut. Trees will be chosen on the basis of its adaptability to your street plan. TREE BENEFITS Trees provide beauty and summer cooling, reduce air pollution, decrease stormwater runoff and add to the overall character of a neighborhood.

Please contact Steve Hladun @203-576-7797 or Steve.Hladun@bridgeportct.gov with any for information. City of Bridgeport, Parks and Recreation Department. 7 Trumbull Rd, Trumbull, CT, 06611