HomeMy WebLinkAbout2121 Midpoint Dr - Correspondence/Plans Approval - 10/20/2016�t, ` 0 I DWelo ment &Neighborhood Services
6e C® �� 281 N. College Ave. Fort Collins, CO 80522; Voice: 970 221 6760
�`- FAX: 970-224-6134
CONSTRUCTION WASTE MANAGEMENT PLAN and DOCUMENTATION
Note: Environmental Services staff is able to assist with questions about getting a recycle program
implemented, and will also provide education and site visits upon request (call Caroline Mitchell at (970)
221-6288).
PROJECT INFORMATION
Address Z I !Zt Date I
Permit No. l 15 ZS
General Contractor & Contact Info: �a-���`�cy.7`c'S Ctu-S4RJ_-_dl
Material
Vendor hauling the
materia12
Facility recycling the
materia13
Total volume or weight
of material4
Concrete/Masonry
Wood/Lumber
Metals
g� �-
Cardboard
Trash
N/A
Other (describe)
Required Documentation 4: Provide signed documentation from the hauling company that the volumes &
weights listed above are accurate. If you hauled the materials yourself, attach tickets from locations receiving
the recyclables. Documentation is required in order to receive final project approval from the City.
I and my City -licensed hauler certify that the above materials from my construction site were recycled in the
volume / wei t describe and were taken to the facilities described.
/0 -A0
S g ature (Contractor or Owner) Date
Signature (Licensed Hauler)
Date
'At minimum, the four listed materials must be recycled.
2 Enter vendor name and phone number. If the applicant will haul the material themselves, state such.
'Where will applicant or vendor take the material for recycling? Enter facility name and address.
4 To be completed at the end of the project. Please re -submit this form at end of project with these sections completed.
Rev 1/15/14