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Name _________________________________________ Phone ________________________Address _______________________________________________________________________
City/State/Zip ___________________________________________________________________
Mailing address (if different from above)____________________________________________________________________________________
I request that the Larimer County Weed District not apply any herbicides to the right-of-way next to the property I control.
Side of property (North, East, South, West)________________________
From (Give specific landmarks) _______________________________________________________________________________________
To (Give specific landmarks) _______________________________________________________________________________________
County Road ________________________
Side of property (North, East, South, West)________________________
From (Give specific landmarks) _______________________________________________________________________________________
To (Give specific landmarks) _______________________________________________________________________________________
County Road ________________________
Side of property (North, East, South, West)________________________
From (Give specific landmarks) _______________________________________________________________________________________
To (Give specific landmarks) _______________________________________________________________________________________
I have posted/will post these areas with DO NOT SPRAY signs so that they are clearly visible and the area is well defined.
I understand that by requesting that no herbicides be used in this area, I am now responsible for the vegetation management on the above described portion(s) of this right-of-way, including height control, annual weed control, and noxious weed control.
Signature ____________________________________________________ Date_______________
Please return this form to: Larimer County Weed District, PO Box 1190, Fort Collins, CO 80522-1190