HomeMy WebLinkAbout2313 Northbrook Dr - Special Inspections/Field Verification - 02/13/2013City Of Community Development & Neighborhood Services
Flirt Collins`I281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site 2,3 f3 1L)6r-4-h broo k Permit No. 6 L300 ,;L&B
Company Name 10(P)[4City of Ft Collins Lic# l9SKZR
Replacement of Sewer line approx. _ft. (100 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
Add Replace gas line approx. !;14 ft. ( 50 ft. maximum)
Materials used: k)ae-4( Tl.,K 647-
Tested at / 6 Lbs. for /.1 minutes
Installer Name (print) ra.(j i� u -�cV
Installer Signature Atx ro � , Date �"h'71)