Laserfiche WebLink
AUTHORIZATION FOR MOSQUITO CONTROL <br />FOR <br />LARVAL AERIAL APPLICATIONS IN BRADLEY WOODS <br />SIGNING AND RETURNING the copy of this authorization form will authorize the <br />Clarke Environmental Mosquito Management, Inc. to perform Larval Control within <br />the stipulated limits found on this cost estimate unless otherwise stated. <br />CONTACT FOR AUTHORIZA'TION: <br />NAME: <br />ADDRESS: -7 <br />CITY/STATE/ZIP: <br />4v`'- PHONE: 7 S Ze?J <br />?? 1-V ox/'/ s- <br />FOR CLARKE ENVIRONMENTAL MOSQUITO MANAGEMENT, INC.: <br />SIGNATURE: <br />Brian P. Deenihan <br />TITLE: Control Consultant DATE: <br />FOR THE CUYAHOGA COUNTY BOARD OF HEALTH: <br />SIGNATURE: ?TITLE: DATE: <br />FOR THE CITY OF WESTLAKE: <br />SIGNATURE:.'.,?'?-Q,'?" DATE: 3 <br />FOR THE T O?ZAIN COUNTY HEAL,TH DEPARTMENT: <br />??wc ' r'a?? DATE: / a3 <br />SIGNATURE: TITLE: <br />FOR THE CLEVELAND METRO ARK SYSTENI: <br />p iSIGNATUR TITLE ATE:,g 27? 03 <br />a k <br />FOR THE CITY OF NORTH OLMSTED: <br />\ ?TITLE: 4 ? DATE: <br />SIGNATURE: <br />/?? <br />.az:..m"Nx.m?+?hh?b*ta?it',+"' ' . ... _?w?a ev, n . .. ? . . _ .. . ? ..,..?- -???..dA^SrmAa? .'?sr„ ?:z?F,r„ ? ? •