CITY OF SOUTH BEND - MOSQUITO ABATEMENT PROGRAM - 2012
Below please find an “Authorization and Release” that, when signed by you, will authorize us to inspect, analyze, and treat your property for the purpose of mosquito abatement in the City of South Bend, Washington. Please note that a new release will be needed every year that this program is in effect.
AUTHORIZATION AND RELEASE
In consideration of my interest as a resident and/or property owner in South Bend, Washington, and realizing that mosquito control is essential for my family’s health the same as for that of others, I hereby authorize the City of South Bend or it’s representatives to enter my land for the purpose of mosquito abatement through the use of the following methods:
- Inspection
- Testing and Analysis
- Treatment of Areas
For the same consideration, I also release and agree to hold harmless the City of South Bend and its officers and representatives in their official or individual capacities for any damage that may arise from the use of the above-mentioned methods in its efforts to affect mosquito control on my property.
Instructions: To complete the form, please click print below, sign the form, and return it to City Hall.
CITY OF SOUTH BEND - MOSQUITO ABATEMENT PROGRAM - 2012
AUTHORIZATION AND RELEASE
In consideration of my interest as a resident and/or property owner in South Bend, Washington, and realizing that mosquito control is essential for my family’s health the same as for that of others, I hereby authorize the City of South Bend or it’s representatives to enter my land for the purpose of mosquito abatement through the use of the following methods:
- Inspection
- Testing and Analysis
- Treatment of Areas
For the same consideration, I also release and agree to hold harmless the City of South Bend and its officers and representatives in their official or individual capacities for any damage that may arise from the use of the above-mentioned methods in its efforts to affect mosquito control on my property.
Signature:____________________________________
