1. Fill in all information regarding the person
or organization requesting treatment. Make sure to fill in
the customer's name who should be contacted if there are any
questions. Fill in this information even if the customer and
applicator, as specified in item #2, are the same.
2. Fill in all applicator and organization
or applicator business information. The applicator must be
certified in either Category 8B (mosquito) or 8C (campground).
The applicator and/or the applicator business must be licenses
for the current license year.
3. Check which type of application applies
to your proposed treatment.
4. Fill in the County and Municipality in
which the treatment will be performed.
5. Fill in the areas to be treated. Be specific
here, for example: campground areas, golf course hole numbers,
bodies of water, etc. If you intend to apply a larvicide to
a body of water follow the label directions carefully. The
program may request additional information or clarification.
6. Fill in the target pests you intend to
7. Check the method you will use to determine
when to treat. For example: coordinate with your County Mosquito
Control Agency, hire a professional consultant, spray according
to citizen complaints, etc.
8. Enter the information concerning the pesticide(s)
you propose to use. Enter product name(s) and EPA registration
number(s). Fill in the dilution rate you intend to use. Leave
this blank if this is a ULV application. Enter the calibrated
application rate you will use. Fill in the method of application
you propose, for example: ULV, thermal fog, mist blower, hand
scatter, aerial, etc. If you want to make a change in your
treatment program after you have received an approved permit,
call the Pesticide Control Program for a revised permit.
9. Attach a copy of a map which indicates
the area to be treated. Mark on this map the specific area(s)
of treatment you filled in under item #5 of the permit. Permit
applications will be returned if the map is unclear, incomplete
Note: The applicator must then sign
his name stating that he agrees to follow all the most current
label directions for the pesticide(s) to be used; will be
responsible for all damages which may occur from the proposed
treatment; will abide by any conditions placed on the permit
upon approval; and will submit the required records of application
to the county mosquito control agency and the Pesticide Control
Program within 3 weeks of the application.
If the proposed treatment is for fly control,
send your application directly to the Pesticide Control Program
(see address below.)
If the proposed treatment is for mosquito
control, contact your County
Mosquito Control Agency to arrange to have your equipment
inspected and to discuss your proposed control program. Your
equipment should be properly maintained and calibrated beforehand,
so that you can actually demonstrate it to the county. Bring
this permit application with you to your county mosquito control
agency. They need to sign-off on it. The county mosquito control
agency will send the application to the Pesticide Control
Program for our review. If your county mosquito control agency
will not cooperate in this program, contact the Pesticide
Control Program at (609) 984-6666 for alternate instructions.
10. Fill in the make, model and serial number
of each sprayer you check. If you need more room please attach
an additional page to the application.
11. Check whether the equipment is properly
maintained and calibrated. If you have checked a ULV sprayer,
fill in the mass median diameter (MMD) of the spray droplets
in the space provided. If there are any irregularities or
the machine is not in running condition when you inspect it,
please note this.
12. Check whether or not you recommend the
proposed mosquito/fly larviciding/adulticiding program.
13. Explain the reason for your recommendation
or objection to this spray program. Your technical assistance
and professional evaluation of this proposed spray program
serves as valuable information in the permit process. If the
county is already providing mosquito control in the proposed
treatment area, we must be informed.
Note: Sign and date the permit application
upon completion of your review.