Mosquito Spraying Avoidance Request

2. 
4. Mosquito Spraying Avoidance Request
   I DO NOT wish for my property to be included in the adulticiding (ground spraying) service provided by mosquito control using a vehicle mounted ultra-light volume (ULV) spray machine for the following reason(s):
6. Reasons:

   1. Beekeeper

   1. Other (Please Explain)
8. Other (Please Explain):
10. I understand that a new release form must be obtained from, completed, and returned to Mosquito Control each calendar year.
12. I understand that a yard inspection for standing water/mosquito breeding habitat is required.
14. Please Note:

    Mosquito Control reserves the right to spray in the case of a West Nile Virus positive test result within a mile and a half of the residence. 

    
    

16. Name:*
17. Phone:*
19. Address:*
21. Email Address:*
23. Electronic Signature:*
24. Date:*
    Date:
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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