HomeMy WebLinkAbout4006 Big Dipper Dr - Special Inspections/Field Verification - 01/05/2021FCity of Community Development Ilk Neighborhood Services
ort Collins 281 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 40010 W1I biPP�Y br, Ra flaWn9, A W5a'$ Permit No. b a@0m 1 l0 2'
Company Name 13�n J OV}'I'Vt Vl �rGtN1, ILl I VL p l U hNb l Yl City of Ft Collins Lic#
Replacement of Sewer line approx. 4f* ft. 000 ft. maximum)
Replacement of Water line approx. ft. (100 ft. maximum)
X Add Replace gas line approx._ ft. ( 50 ft. maximum)
Materials used:
Tested at S Lbs. for ?v minutes
Installer Name (print) )2 So vt Fa w I ec—
Installer Signature AAaL,,/-, Date ` ° 5
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