Pesticide Regulation Bylaw 4518 (2011)

Oak Bay, British Columbia

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THE CORPORATION OF THE DISTRICT OF OAK BAY BYLAW NO. 4518 A Bylaw to regulate the use of pesticides WHEREAS: A. the Municipal Council of The Corporation of the District of Oak Bay is concerned about the non-essential use of pesticides and the risk that pesticides may pose to the natural environment; B. the application of pesticides contributes to the cumulative chemical load absorbed by the natural environment; C. pesticides cannot be necessarily confined to a single location but move through the environment in the air, land and water and may have an impact on non-target organisms and plants; D. alternatives to the application of pesticides exist; E. the precautionary principle supports local governments anticipating and preventing threats of harm to the environment, even if some cause-and-effect relationships have not been fully established scientifically; F. local governments have jurisdiction to pass bylaws regulating the application of pesticides pursuant to Sections 8(3)(j) and 9 of the Community Charter and B.C. Reg. 144/2004 (Spheres of Concurrent Jurisdiction - Environment and Wildlife Regulation); Now therefore the Municipal Council of The Corporation of the District of Oak Bay, in open meeting assembled, enacts as follows: 1 In all portions of this Bylaw other than Schedule "A" attached to and forming part of this Bylaw, "infestation" means the presence of pests in numbers, or under conditions, that involve an immediate or potential risk of substantial loss or damage; "invasive species" means an alien species whose introduction does or is likely to cause environmental or economic harm, or harm to human health; "Manager of Parks Services" means the Manager of Parks Services for the Municipality and includes in his absence or unavailability a person employed by the Municipality authorized by him to act on his behalf; "Municipality" means The Corporation of the District of Oak Bay; Bylaw No. 4518 2 "noxious weeds" means plant species that are capable of causing ill health in humans; "permitted pesticide" means a pesticide listed in Appendix "1" of Schedule "A" attached to and forming part of this Bylaw; "pest" means an injurious, noxious or troublesome living organism, but does not include a virus, bacteria, fungus or internal parasite that exists on or in humans or animals; "pesticide" means a micro-organism or material that is represented, sold, used or intended to be used to prevent, destroy, repel or mitigate a pest, and includes: (a) a plant growth regulator, plant defoliator or plant desiccant; (b) a control product as defined in the Pest Control Products Act (Canada); and (c) a substance that is classified as a pesticide by regulation under the Integrated Pest Management Act; "precautionary principle" means that the absence of full scientific certainty shall not be used as a reason to postpone decisions where there is a risk of serious or irreversible harm; "private land" means a parcel or part of a parcel if the parcel or part is used for residential purposes and is not public land, and for the purposes of this Bylaw, a parcel which is not occupied in whole or in part by a dwelling is deemed nonetheless to be used for residential purposes if it is categorized in its entirety as Class 1 - Residential pursuant to B.C. Reg. 438/81 (Prescribed Classes of Property Regulation) under the Assessment Act; "public land" means land vested in the Municipality; "sensitive ecosystem" means private or public land with one or more of the following characteristics: (a) areas or landscape features identified in the Sensitive Ecosystems Inventory for Eastern Vancouver Island and the Gulf Islands, or species and ecosystems listed by the Conservation Data Centre, both published by the British Columbia Ministry of Environment; (b) land designated in the Official Community Plan of the Municipality as a development permit area for the protection of the natural environment, its ecosystems or biological diversity; or Bylaw No. 4518 3 (c) park land vested in the Municipality, other than portions thereof used and maintained as playgrounds or playing fields. 2 Except as permitted in this Bylaw, no person may apply or otherwise use a pesticide for the purpose of maintaining outdoor trees, shrubs, flowers, other ornamental plants and turf, on private land or public land. "Maintain", for the purpose of this Section, means the control, suppression or eradication of a pest. 3 Section 2 does not prohibit or regulate the application of a pesticide: (1) that is a permitted pesticide as listed in Appendix "1" of Schedule "A" attached to and forming part of this Bylaw; (2) for the management of pests that transmit human diseases or impact agriculture or forestry; (3) on the residential area of a farm; (4) on land used for agriculture, forestry, transportation, public utilities or pipelines unless the public utility or pipeline is vested in the Municipality; (5) to buildings or inside buildings; or (6) on public land, when undertaken by or under the control of the Municipality and in accordance with Schedule "A" attached to and forming part of this Bylaw. 4 (1) A person may apply to the Manager of Parks Services for a permit to use a pesticide on private land in the following circumstances: (a) where a pest infestation: (i) threatens the integrity of a sensitive ecosystem; or (ii) will cause significant economic loss to an owner or occupier of land; or (b) where required to control the spread of invasive species or noxious weeds. (2) Application for a permit shall be made using the form set out in Schedule "B" attached to and forming part of this Bylaw and must be accompanied by a non-refundable application fee in the amount of $25.00. (3) The Manager of Parks Services shall issue a permit where he is satisfied that the criteria set out in Section 4(1) have been met, and that the proposed pesticide use is in accordance with all applicable enactments and Bylaw No. 4518 4 regulations of the authorities having jurisdiction. Otherwise, the Manager of Parks Services shall refuse to issue a permit. (4) In issuing a permit, the Manager of Parks Services may impose conditions: (a) which, in his assessment, are required to protect living organisms other than pests; (b) limiting the species of plant or pest to which the pesticide may be applied; (c) demarcating the area of land on which the pesticide may be applied; and (d) limiting the period of time during which the pesticide may be applied, and no person shall fail to comply with such conditions. 5 A person who has obtained a permit to use a pesticide pursuant to Section 4 must provide written notice of the use of the pesticide in accordance with Sections 6 through 8. 6 Written notice must be posted on land where the pesticide will be used and must comply with the following requirements: (1) The notice must be posted on the land at least 48 hours before the pesticide will be used; (2) The notice must remain on the land until the later of 72 hours after the application of the pesticide or the time, if any, indicated on the product label specifying when the area can safely be re-entered after application; (3) Notices must be posted in locations that are clearly visible from each highway or public pathway adjoining the land, and (a) within three metres of each of the property lines intersecting each highway or public pathway; and (b) at driveways, walkways, and other usual entrances to the land; (4) The notice must be made of material that is weather resistant; (5) The notice must have a width not less than 22 centimetres and a height not less than 28 centimetres; (6) The notice must include the following information: Bylaw No. 4518 5 (a) the location, date and approximate time of the pesticide use; (b) in the event of inclement weather, an alternate date or dates on which the pesticide use may occur; (c) the brand name and registration number of the pesticide that will be used; (d) the pest for which the pesticide is being used; (e) the time, if any, indicated on the product label specifying when the area can safely be re-entered after application; and (f) the following phrase: "Permission to undertake this activity was obtained from the District of Oak Bay. Further details may be obtained from the Oak Bay Parks Department office, 1771 Elgin Road." 7 Written notice must be delivered to residents of parcels that are adjacent to the land where the pesticide will be used and must contain the information set out in Section 6(6). 8 For the purpose of Section 7, an adjacent parcel includes one which is separated from the subject land by a street, lane, public walkway or, in the case of a bare land strata plan, the portion of the common property comprising the access route. 9 Sections 6 through 8 apply to the use of a pesticide, other than a permitted pesticide, on public land. 10 In this Bylaw, a reference to a statute or regulation means a statute or regulation of the Province of British Columbia unless otherwise specified, and includes a like provision in an amendment or successor statute or regulation. 11 Any person who contravenes this Bylaw by doing an act which it forbids, by omitting to do an act which it requires to be done, or by failing to comply with a condition or order imposed hereunder, commits an offence punishable upon summary conviction and is liable to a fine of not more than Ten Thousand Dollars ($10,000.00). 12 A separate offence shall be deemed to be committed on each day during and on which a contravention of this Bylaw occurs or continues. 13 If any part of this Bylaw is declared invalid by a court of competent jurisdiction, the remainder shall continue in full force and effect and be construed as if the Bylaw had been adopted without the invalid portion. 14 This Bylaw shall come into effect on April 1, 2011. Bylaw No. 4518 6 15 This Bylaw may be cited as the Pesticide Regulation Bylaw, 2010. READ a first time by the Municipal Council on November 22, 2010 READ a second and third time by the Municipal Council on January 10, 2011 ADOPTED AND FINALLY PASSED by the Municipal Council on January 24, 2011 Mayor Municipal Clerk Sealed with the Seal of The Corporation of the District of Oak Bay Bylaw No. 4518 7 SCHEDULE "A" DISTRICT OF OAK BAY INTEGRATED PEST MANAGEMENT POLICY 1. Purpose This policy describes the approach to pest management used on public lands within the District of Oak Bay. The Integrated Pest Management (IPM) approach is designed to eliminate the non-essential use of pesticides. IPM is not a single pest control method but, rather, is a series of pest management evaluations, decisions and controls. It is consistent with the precautionary principle as set out in the Pesticide Regulation Bylaw. 2. Need for Policy Many citizens are concerned about the amount and location of pesticide applications and associated health and environmental impacts. The Municipality recognizes its unique location and environment and celebrates the need to safeguard its waterways, ecological habitats, and cultural heritage. An IPM policy is an important component in environmental stewardship of these features. This IPM policy demonstrates Oak Bay's commitment to eliminating non-essential pesticide use on public lands, with the highest standards possible. 3. Definitions Action level: The level of pest population establishment when action must be taken to prevent the population from reaching the injury level. Biological control: The use of living organisms (parasites, predators, pathogens) that have been approved by the Pest Management Regulator Agency (PMRA) or Health Canada to manage pests. Chemical control: The use of a synthetic chemical pesticide to suppress or control a pest. Cultural practices: Management practices that focus on the prevention of pests by maintaining healthy hosts through proper planting, pruning, mulching, irrigation, nutrient requirements and sanitation practices. Early detection / rapid response (EDRR): A coordinated approach to invasive species or noxious weed management that focuses on identifying, surveying, and monitoring selected areas to detect populations of invasive species that are new to Bylaw No. 4518 8 or approaching a region, and to prevent their expansion at or before their earliest stage of establishment. Ecological approach: Planning and management activities that consider ecosystems and the relationships among and between all organisms, including humans, and their environment. Ecosystem: A complex system of organisms and their physical environment that function together, circulating nutrients and energy. Invasive species: An alien species whose introduction does or is likely to cause environmental or economic harm, or harm to human health. Injury threshold: The point in growth of a pest problem where it will cause an unacceptable impact upon: public safety, recreation or health; natural and/or managed ecosystems; economic injury to desirable plants; or the integrity, function or service life of facilities. Integrated pest management (IPM): A process for managing pest populations that includes the following elements: (a) planning and managing ecosystems to prevent organisms from becoming pests; (b) identifying pest problems and potential pest problems; (c) monitoring populations of pests and beneficial organisms, damage caused by pests, and environmental conditions; (d) using injury thresholds in making treatment decisions; (e) suppressing pest populations to acceptable levels using strategies based on considerations of biological, physical, cultural, mechanical, behavioural and chemical controls in appropriate combinations, and environmental and human health protection; and (f) evaluating the effectiveness of pest management treatments. Integrated pest management program: A program for managing pest populations or reducing damage caused by pests, using integrated pest management principles. The IPM program is implemented through a series of landscape-specific plans that describe the methods of handling, preparing, mixing, applying and otherwise using pesticides and pest management methods within that program. Native species: Organisms that have not been introduced to a place by people or their direct activities; that are known to have existed in an area prior to the influence of humans. Bylaw No. 4518 9 Natural areas: Spaces containing representative biological, physical or historical components. They either retain or have had re-established a natural character, although they need not be completely undisturbed. Noxious weeds: Plant species that are capable of causing ill health in humans. Permitted pesticide: A pesticide listed in Appendix 1 to this policy. Pest: An injurious, noxious or troublesome living organism, but does not include a virus, bacteria, fungus or internal parasite that exists on or in humans or animals. Pesticide: A micro-organism or material that is represented, sold, used or intended to be used to prevent, destroy, repel or mitigate a pest, and includes: (a) a plant growth regulator, plant defoliator or plant desiccant; (b) a control product as defined in the Pest Control Products Act (Canada); and (c) a substance that is classified as a pesticide by regulation under the Integrated Pest Management Act; Precautionary principle: The principle that the absence of full scientific certainty shall not be used as a reason to postpone decisions where there is a risk of serious or irreversible harm. Preventative measures: Management practices that are directed towards preventing the establishment of pests (e.g., site design, generic material, optimal site selection for plant material, proper planting and cultural practices, etc.) 4. Policy Statement The Municipality will manage pests through an IPM program that is designed to eliminate the non-essential use of pesticides by applying the following principles and practices: 4.1 Principles (a) Ecosystems will be managed and landscapes planned to prevent organisms from becoming pests. An ecological approach that uses appropriate preventative measures will be applied, with consideration given to native species diversity. (b) Safeguarding human health, the environment, and non-target organisms will be primary considerations when developing pest management strategies, action levels and injury thresholds. Bylaw No. 4518 10 (c) A formal system will be undertaken to monitor populations of pests and beneficial organisms, pest damage, and environmental conditions. Monitoring means the regular surveying of sites and/or features to understand and identify the location and extent of potential pest management problems. (d) Written, photographic, and map records will be maintained and used to record monitoring data and to develop future pest management plans. Records will describe the target pest, implementation timetables, specific management factors used, alternative methods assessed and/or implemented, type and quantity of pesticide used, site and area of application, certification that notification was made, measurable responses to treatments; costs and amounts labour and materials used; results of pest management upon ecosystems and aesthetic values; economic injury to desirable plants, if any, and/or to the integrity, function, or service life of facilities. All of this information shall inform the decision-making process and be used in the evaluation of each IPM plan. (e) Data collected through monitoring and record-keeping will be used to regularly evaluate treatment effectiveness. This includes analysis of treatment strategies and the modification of existing Pest Management Plans. (f) As a provincially accredited pesticide licence holder, the Municipality will submit an Annual Report of Pesticide Use to the Ministry of Environment. (g) An education program will be initiated that: (i) encourages the community to accept higher levels of weeds in exchange for diminished use of synthetic chemicals, and (ii) informs the community about pest occurrences and threats with the goal of encouraging changes in behavior that result in improved pest control and reduced threats. (h) Potential and confirmed pest problems will be addressed using a combination of cultural, physical, mechanical, biological, behavioural, and chemical treatments to suppress pests to acceptable levels. Greater emphasis shall be placed on prevention and reduction than control. (i) Injury thresholds and action levels for each landscape type will be established and used in making treatment decisions. (j) Chemical pesticides will be used only when other options are not available, feasible, or effective. The least toxic pesticide that effectively controls the pest will be used. Such pesticides generally have short residual effects and/or specifically affect target pests. Such pesticides: (i) are least disruptive of natural (e.g., biological) controls; Bylaw No. 4518 11 (ii) are least hazardous to human health; (iii) minimize negative impacts to non-target organisms; and (iv) are least damaging to the general environment. (k) Treatment actions shall be applied during the most vulnerable time in the life- cycle of the pest while having the least impact on natural predators and non- target organisms. (l) An early detection / rapid response (EDRR) approach will be adopted to ensure new pests are prevented from spreading, with the goal being eradication. (m) Cost-effectiveness will be determined and applied, inclusive of long-term maintenance of various public facilities and landscapes. 4.2 Training To ensure appropriate and current understanding and implementation of IPM principles, municipal staff involved in pest management will be provided with necessary and appropriate training, including but not limited to Pesticide Applicator's certification and qualification for the Plant Health BC Pest Management Accreditation program. 4.3 Compliance and Coordination The IPM Program shall be managed and coordinated by a municipal staff person who is a licensed pesticide applicator. 5. Regulatory Context and Application The implementation of the IPM policy is subject always to applicable federal and provincial enactments including but not necessarily limited to: Pest Control Products Act (Canada), Fisheries Act (Canada), Migratory Birds Convention Act (Canada), Plant Protection Act, Workers' Compensation Act, Integrated Pest Management Act and Regulations, Environmental Management Act, Weed Control Act, Wildlife Act, and Invasive Plants Regulation (Forest and Range Practices Act). The IPM policy applies to all land vested in the District of Oak Bay. 6. Treatment Notices Bylaw No. 4518 12 6.1 Regulatory Requirements Any municipal department or contractor doing work for the Municipality that is using pesticides must post a Treatment Notice in compliance with the requirements set out in the Integrated Pest Management Regulation, Section 10. Blank forms are available from the Ministry of Environment. The following specifications apply to a Treatment Notice: (a) Treatment Notice Size The minimum size of the treatment notice for outdoor posting is approximately standard letter size (22 x 28 cm). The notice is to be clearly visible to a person approaching a treated area. It may be appropriate to increase the size of the notice so that it can be posted at less frequent intervals around the treatment area and still meet the "clearly visible" requirement. (b) Treatment Notice Content The following is provided to assist in completing the content requirements: (i) Description of the treatment area: must be specific enough to allow the reader to accurately identify the area being treated. (ii) Name of targeted pest: describe either the pest or the pest complex. Be specific enough to allow the reader to confirm that the pest is listed on the pesticide label (e.g., leafrollers, powdery mildew, broadleaf weeds). (iii) Registration number and active ingredient(s) of the pesticides to be used: these are Pest Control Product Act (Canada) Registration numbers and the active ingredients under the "Guarantee" on the pesticide label. (iv) Date and start time and any proposed alternate dates for pesticide use: are to be listed so that the public knows when the treatment was done or is to be done. An alternate date and time should be provided if a treatment may be postponed due to adverse weather conditions (e.g. rain or winds over 8 km/hr). The alternate date is not to be used to identify possible re- treatments: new notices should be posted close to the actual treatment date. (v) Name of licensee and license number and a phone number of the licensee where a person can obtain more information: where a person can obtain information on the treatment method or what will be or was treated. (vi) Precautions to minimize exposure to a pesticide or its residues, including the period during which people should not enter a treated area: when such precautions are specified on a label or Material Safety Data Sheets, these should be included on the posted notice. A typical precaution is to Bylaw No. 4518 13 avoid contact with treated areas. For unprotected worker re-entry to a treated site, WorkSafeBC has identified minimum re-entry times. These should be placed on the notice when appropriate. (c) Locations for Treatment Notice Postings The primary aim in posting treatment notices is to ensure that individuals entering a treatment area are aware that treatment will occur near their residences, or for general public areas so that individuals are alerted that treatment has occurred before they enter the treatment area. Suggested locations for posting include: (i) So that it can be seen as a person approaches each gate or opening to a treatment that occurs within a fenced area; and (ii) At intervals around the treated area so that a notice will be clearly visible to anyone approaching the treated area from the different directions that it may be accessed. The spacing of notices will depend on the size of the notice and lettering. Notices should generally be posted beside paths leading to a treated area. Note that the Integrated Pest Management Regulation stipulates that posting is required when a pesticide is used in an outdoor public use area, defined as a landscaped area maintained for public passage or recreation. The Ministry of Environment considers examples of these areas to be: turf in parks, ornamental beds in parks where people walk or play and areas immediately adjacent to them, school playgrounds and fields, the land around bus stops and rest areas and points of interest; and boulevards in residential and commercial areas (where people may walk across them). Examples of areas that the Ministry of Environment considers do not require posting are boulevards and medians along highways or in industrial areas, away from residential or commercial buildings and stopping areas. 6.2 Additional Notification Effort In addition to the above regulatory notice requirements, the Municipality shall take further steps to inform and educate the public about the IPM program, as follows: (a) When required to post signs: (i) At a location where a synthetic pesticide is to be used, Treatment Notices will be printed on red paper or paper with a red border. On the back of each notice, text will be provided that explains in plain terms why a synthetic chemical is being used; for example, to control an infestation of introduced alien plant that threatens a rare native species or critical habitat. Bylaw No. 4518 14 (ii) At a location where a fertilizer is to be used, a notice will be printed on green paper or paper with a green border that provides the dates and nature of treatment and a contact name and number the public can use if they have questions. (b) At a location where a permitted pesticide is to be used, Treatment Notices will be printed on yellow paper or paper with a yellow border. On the back of each notice, text will be provided that explains in plain terms why the treatment is being applied; for example, to control weeds where other methods have failed. 7. Exclusions The IPM policy does not apply to the use of a pesticide for the following purposes or in the following situations, as the case may be: (a) in a public pool; (b) to purify water intended for the use of human beings or animals; (c) inside a building; (d) to control or destroy animals or plants that constitute a danger to human beings; and (e) to control or destroy structure-destroying insects. Bylaw No. 4518 15 Integrated Pest Management Policy, APPENDIX 1 PERMITTED PESTICIDES Consistent with Schedule 2 of the Integrated Pest Management Regulation, the use of the following federally-labeled Commercial and Domestic (or Domestic only, as indicated) pesticides is not subject to this policy except for the notice protocol set out in Section 6.2(b): 1. acetic acid (DOMESTIC) 2. animal repellents (DOMESTIC and COMMERCIAL) except thiram 3. anti-fouling paints (DOMESTIC and COMMERCIAL) 4. antisapstain wood preservatives used on private, industrial land owned by the company or person responsible for the application (COMMERCIAL) 5. asphalt solids (pruning paints) (DOMESTIC and COMMERCIAL) 6. bacillus thuringiensis kurstaki (Btk) (DOMESTIC) 7. bactericides used in petroleum products (DOMESTIC and COMMERCIAL) 8. boron compounds (DOMESTIC) 9. boron compounds with up to 5% copper for insect control and wood preservation (COMMERCIAL) 10. capsaicin (DOMESTIC, COMMERCIAL and RESTRICTED) 11. cleansers (DOMESTIC and COMMERCIAL) 12. corn gluten meal (DOMESTIC and COMMERCIAL) 13. d-phenothryn (DOMESTIC) 14. d-trans-allethrin, also referred to as d-cis, trans allethrin (DOMESTIC) 15. deodorizers (DOMESTIC and COMMERCIAL) 16. fatty acids (DOMESTIC) 17. ferric phosphate (DOMESTIC and COMMERCIAL) 18. ferrous sulphate (DOMESTIC and COMMERCIAL) Bylaw No. 4518 16 19. hard surface disinfectants (DOMESTIC and COMMERCIAL) 20. insect bait stations (DOMESTIC) 21. insect pheromones (DOMESTIC and COMMERCIAL) 22. insect repellents (DOMESTIC) 23. laundry additives (DOMESTIC and COMMERCIAL) 24. material preservatives (DOMESTIC and COMMERCIAL) 25. methoprene (DOMESTIC) 26. mineral oils for insect and mite control (DOMESTIC) 27. n-octyl bicycloheptene dicarboximide (DOMESTIC) 28. naphthalene for fabric protection (DOMESTIC) 29. paradichlorobenzene for fabric protection (DOMESTIC) 30. pesticides in aerosol containers (DOMESTIC) 31. pesticides registered under the federal Act for application to pets (DOMESTIC and COMMERCIAL) 32. piperonyl butoxide (DOMESTIC) 33. non-synthetic plant growth regulators (DOMESTIC) 34. polybutene bird repellents (DOMESTIC and COMMERCIAL) 35. pyrethrins (DOMESTIC) 36. resmethrin (DOMESTIC) 37. rotenone (DOMESTIC) 38. silica aerogel, also referred to as silica gel, amorphous silica and amorphous silica gel (DOMESTIC and COMMERCIAL) 39. silicon dioxide, also referred to as "diatomaceous earth" (DOMESTIC and COMMERCIAL) 40. slimicides (COMMERCIAL) 41. soaps (DOMESTIC and COMMERCIAL) Bylaw No. 4518 17 42. sulphur, including lime sulphur, sulphide sulphur and calcium polysulphide (DOMESTIC) 43. surfactants (DOMESTIC and COMMERCIAL) 44. swimming pool algicides and bactericides (DOMESTIC and COMMERCIAL) 45. tetramethrin (DOMESTIC) 46. wood preservatives (DOMESTIC) 18 SCHEDULE "B" PESTICIDE USE PERMIT APPLICATION FORM CORPORATION OF THE DISTRICT OF OAK BAY PESTICIDE REGULATION BYLAW PESTICIDE USE PERMIT APPLICATION FORM Note: An application must meet one of the following requirements in order to be considered:  a pest infestation that threatens the integrity of a sensitive ecosystem  a pest infestation that will cause significant economic loss to owner of land  to control the spread of invasive species or noxious weeds APPLICANT (Please Print) Name Address Postal Code Phone Fax E-mail OWNER (Please Print) Name Address Postal Code Phone Fax E-mail Name of pesticide to be used Dates of proposed use Name of pest or plant targeted Name / phone number of certified applicator Reason for application for permit based on principals of integrated pest management as defined in the bylaw: Description of area to be targeted with pesticide: Address where pesticide is to be applied:  In making this application the owner agrees to permit access to the property at all reasonable times by Oak Bay staff for purposes of conducting inspections of the property. I hereby certify that the information is true to the best of my knowledge AUTHORIZATION Required if applicant is not the registered owner SIGNATURE OF APPLICANT SIGNATURE OF OWNER DATE DATE STAFF USE ONLY Official Stamp Permit Fee : $ Permit #: Pesticide Application Approved  Denied  Reason: Applicant notified: In person  by phone  by mail  by email 