Document: 2751763
Pesticide Use Permit Application
Pesticide Control Use Bylaw 7686 Schedule A
District of North Vancouver
Environment Department
355 West Queens Rd, North Vancouver, BC V7N 4N5
Questions about this form: Phone: 604-990-2311
Form submission: Submit to address above or by fax to 604-984-9683 or email a signed, scanned copy to
COMPLETION: To ensure legibility, please complete all sections online then print the completed
form. Sign the printed copy and submit to the department and address indicated above along with
supporting documentation, if applicable. Please note: Incomplete information may delay the
review of your application. Please ensure you have completed all sections in full.
Applicant Information
Site address
Property owner or land manager
Site contact person
Company providing the diagnosis/assessment and supporting documentation (if applicable)
Company Name
Applicant Number
Reasons for the Permit Application
Please describe:
Target pest(s):
Reason for controlling pest(s): is pest a danger to humans OR is pest damaging buildings or
Trade name or common name of pesticide(s) requested:
Alternative pesticides that are available for requested pesticide(s):
The turf or garden practices, pesticide alternatives and the Integrated Pest Management techniques that
have been tried to reduce or eliminate the need for this pesticide:
The number of applications requested:
The location and size of area to be treated in square feet:
Owner or Land Manager’s Authorization
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Pesticide Use Permit Application
Document: 2751763
The personal information collected on this form is done so pursuant to the Community Charter and/or the Local
Government Act and in accordance with the Freedom of Information and Protection of Privacy Act. The personal
information collected herein will be used only for the purpose of processing this application or request and for no
other purpose unless its release is authorized by its owner, the information is part of a record series commonly
available to the public, or is compelled by a Court or an agent duly authorized under another Act. Further information
may be obtained by speaking with The District of North Vancouver’s Manager of Administrative Services at 604-990-
2207 or at 355 W Queens Road, North Vancouver.
Information to Accompany a Permit Application
The process is intended to be rigorous and the applicant must demonstrate that the use of the requested
pesticide is necessary and that attempts have been made to avoid the need for pesticides in the first
The use of pesticides (other than the permitted pesticides) to control weeds in a lawn or pests in a garden
or on trees and shrubs for cosmetic purposes will not qualify for a permit.
A compelling case must be demonstrated for danger to human health, or damage to buildings or
structures and, in particular, an application based on danger to humans or animals must be accompanied
by a doctor's or veterinarian's (as the case may be) letter, stating that health may be detrimentally
affected unless the permit is issued.
An application based on damage to buildings or structures must be ac companied by a letter from a
landscape architect, arborist, an accredited company or pest control service company stating that there is
clear evidence of damage to buildings and structures making necessary the use of the pesticide applied
for in the permit application.
For District Use Only
Date issued
Permit expires six (6) months after the date of issue