Replant South Mississippi

Site Agreement & Assessment Form

2009-2010 Planting Season

Please return completed form to: Pass Christian City Hall

Replant Pass Christian is allocating 3 trees per family

Trees available – Live Oaks, Bald Cypress, Southern Magnolia, Red Maple, Sweet Gum, Wax Myrtle

Proposed Site Location

Name of Property owner_________________________________________________________

Address of Property owner________________________________________________________

Phone #________________________Email__________________________________________

Location of planting site: (Please provide a sketch on back)______________________________

______________________________________________________________________________

· How many and what species would you like:

____________________________________________________________

____________________________________________________________

Assessment Concerns

· Is the tree clear of any overhead and underground utilities? Yes No, If no why not? ___

· Does the tree have enough room to grow without obstructing traffic, structures, driveways, sidewalks or other trees? Yes No, If no why not ______________________________________________

___________________________________________________________________________

· Have you called Mississippi One Call at 1-800-227-6477? Yes No Call no sooner than two working days prior to planting to verify the location of any underground utilities?

If No, you need to do so. If yes, what is your Locate Request Number?__________________

· Who will be maintaining this tree?________________________________________________

· How will the tree be watered? irrigation system garden hose bucket

· What street is the tree visible from _______________________________________________

(Please continue on back)

Please provide a sketch where the tree(s) are proposed to be planted Show streets, houses or structures and planting locations.

Landowner agreement with Replant South Mississippi

By signing below, I, the property owner of the aforementioned property, accept and acknowledge that I am fully and solely responsible for having my site location marked by Mississippi One Call for possible underground utilities. I hereby declare that I will take full responsibility for any damages that might occur to underground utilities, over-head utilities, or personal property due to Replant South Mississippi tree planting by the volunteer planting crew. I further agree to water and care for the tree(s) in accordance with the tree planting guidelines given to me by Replant South Mississippi and RPM Ecosystems. I agree to make every effort practical to protect the tree in the years to come. Furthermore, I, the owner of aforementioned property, do hereby indemnify and hold harmless the Replant South Mississippi partners and volunteers (specifically the Land Trust for Mississippi Coastal Plain, Home Depot Foundation, Mississippi Forestry Commission and The Sun Herald) from any damages occurring on my property or personal injury as a result of Replant South Mississippi activities. I acknowledge that the tree(s) provide(s) scenic and ecosystem values to the public for years to come; however, this public benefit does not give general access to above property by the public at large.

Signature of Property Owner:___________________________ Date______________