HomeMy WebLinkAbout550 San Juan Dr - Special Inspections/Field Verification - 12/12/2017Fort Collins
Community Development & Neighborhood Services
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 _ 50 qn ,.) Wci✓1 / f.
Company Name We -fQf✓i 6,e e IQI-C? . uDe l y
Replacement of Sewer line
Replacement of Water line
X— Add Replace gas line
Materials used:
Tested at Lbs.
Installer Name (pr
Installer Signature
(Z-V7,17 v
Permit No. /317n:T S-o
City of Ft Collins Lic#
approx. ft. (100 ft. maximum)
approx. ft. (100 ft. maximum)
approx. 36 .. ft. ( 50 ft. maximum)
ford minutes
Date .12 Z/