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2. NO DRIVEWAYS WILL BE CONSIDERED WITHOUT THIS SIGNED FORM

   Private property includes, but is not limited to, lawns and driveways. In order to be considered for service, private driveways must have turnaround space, accessibility, and at least 75 feet of unobstructed length. Driveways will then be sprayed at the discretion of the driver.

   The undersigned grants permission to the Board of County Commissioners for Calvert County, Maryland, by and through its Calvert County Mosquito Control Program, to have access and to enter the undersigned’s property, as identified in the Community Request for Service form attached hereto and incorporated herein by reference, for the purpose of spraying pursuant to the terms and conditions of the program of mosquito control in the County of Calvert, State of Maryland. This permission may be canceled at any time by the property owner in writing to the Calvert County Mosquito Control Program. The Calvert County Mosquito Control Program reserves the right to amend and/or deny service. The undersigned agrees to indemnify, defend and hold harmless the County and its officers and employees from and against all claims, demands, suits, liabilities, damages, losses and expenses resulting from or in any way arising out of the spraying of their driveway pursuant to the terms and conditions of the Calvert County Mosquito Control Program, which causes bodily injury, illness, death or other damage to persons or their property. The consent herein is effective for the 2023 mosquito control season.

   *THIS FORM GRANTS PERMISSION TO ENTER, IT DOES NOT GUARANTEE SERVICE.

4. First Name*
5. Last Name*
7. Community Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email
20. I have read and agree to the above policy and grant permission to enter my private property.*

    1. Yes
    2. No

22. For questions or more information, please contact the Calvert County Department of Public Works, Mosquito Control Division, at 410-535-6924 or mosquitocontrol@calvertcountymd.gov.

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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit

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