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OWNER (mailing address)
Name :
Address :
Telephone :
E-mail :
OWNER’S REPRESENTATIVE (if applicable)
Name :
Address :
Telephone :
E-mail :
Property address :
Localisation :
front yard
backyard
left side yard
right side yard
Number of ash trees to treat :
1.
2.
3.
4.
CONSENT
The owner hereby authorizes the representatives of the City of Beaconsfield and its designated contractor to enter onto its property at the above-mentioned property address, for the purpose of an inspection and, if authorized and paid for by the owner, to proceed to the treatment of the selected ash trees. Furthermore, the owner is hereby advised that the City of Beaconsfield and its designated contractor deny any liability in case the treatment proves to be ineffective and waives any and all claims that it may have now or in the future against the City of Beaconsfield and its designated contractor in relation to the treatment of ash trees.
I hereby authorize the City of Beaconsfield and its representative to proceed for the inspection of the selected ash trees on the above mentioned property, in accordance with the conditions of consent outlined above.