Government of Ontario: Ministry of the Environment

Application for a Permit to Use a Pesticide for Structural Pest Control

Personal information requested on this form is collected under the authority of the Pesticides Act, R.S.O., 1990, Ontario Regulation 63/09. It is used to evaluate applications for permits to use restricted pesticides according to the requirements of the Pesticides Act.

Questions regarding completion and submission of this application should be directed to the Pesticides Specialist in the local Regional Office of the Ministry of the Environment. Regional Office contact information is available on the Ministry of the Environment website at.

Information contained in this application form is not considered confidential and will be made available to the public upon request. Information submitted as supporting information maybe claimed as confidential but will be subject to the Freedom of Information and Protection of Privacy Act (FOIPPA) and the Environmental Bill of Rights (EBR). If you do not claim confidentiality at the time of submitting the information, the Ministry of the Environment may make the information available to the public without further notice to you. If you are identifying confidential material, please indicate why you believe the information is confidential.

Applicant Information

Pest Control Company

Business Telephone Number

Telephone Number
Fax Number







Application Site Information

Full Address of Premises

UTM Coordinates

Schedule - Start of treatment


Schedule - Completion of treatment


Pesticide and Pest Information