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Certification of Notification of Riparian Owners and User

Attachment B
Certification of Notification of
Riparian Owners and User

TO:

Bureau of Pesticide Management
New York State Department of Environmental Conservation

SUBJECT:

Application for Permit to Use Pesticides for the Control of An Aquatic Pest:
______________________________________________________
(Name of applicant as it appears on Permit Application Form)

CHECK ALL APPROPRIATE STATEMENTS

____ All owners of real property abutting the body of water proposed to be treated pursuant to the above-referenced Aquatic Pesticide Permit Application, a list of whom is attached to this letter, have been notified by letter of the proposed pesticide permit. This list includes property owners abutting the outflow from this body of water, if the water is not to be held in the treated water body for the period of time during which use of the water is restricted. Such letters were mailed or personally delivered on: __________________________. A copy of the letter is attached.

____ A review of the appropriate real property tax records indicates that no person other than the applicant owns any real property abutting the water body proposed to be treated pursuant to the above-referenced Aquatic Pesticide Permit application.

____ A person or person not owning abutting real property possesses a vested legal right to use of the water body proposed to be treated. All such persons have been notified by letter of the proposed pesticide permit. A list of such persons, and the nature of their right to use of the water proposed to be treated is attached. Such letters were mailed or personally delivered on: ______________. A copy of the letter is attached.

____ To my knowledge, no person other than the applicant possesses any vested legal right to use the water body proposed to be treated pursuant to the above-referenced Aquatic Pesticide Permit application.

Signed: ____________________________________________________________________
Print or type Name: ___________________________________________________________
Date:______________________________________________________________________
If applicant is not an individual, relationship to applicant: ________________________________

False statements made on this document are punishable under §210.45 of the Penal Law


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