HomeMy WebLinkAbout1312 Sanford Dr - Special Inspections/Field Verification - 05/20/2020FCity. Community Development & Neighborhood Services
or ` Collins 281 N College Ave; P.O. Box 580; Fort Collins, CO 80522-0580
Phone: 970 2216760 FAX: 970 224 6134
Field Verification Form
Job Site Permit No. 1 ZOO4 S15
Company Name City of Ft Collins Lic#
Replacement of Sewer line approx. ft. (100 ft. maximum)
Replacement of Water line approx. —7— ft. (100 ft. maximum)
V Add
' Replace gas line approx. (� ft. ( 50 ft. maximum)
Materials used: C)SESS 2 5+ q 3 /
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Tested at Lbs. for minutes
Installer Name (print) -
Installer Signature �i/i/(� Date $ U�2