HomeMy WebLinkAbout947 WORTHINGTON CIR - CORRESPONDENCE - 1/30/2015 (2)'61
Fcityof(� Community Development & Neighborhood Services
� �✓®llin5 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).
1 y
OA-
PROJECT INFORMATION
Permit No. General Contractor & Contact Info: T D1 nAgeei-N
Material'
Vendor hauling the
materialZ
Facility recycling the
material3
Tot tVolume; o' Wdligh't
of m'atenal4
Concrete/Masonry
Wood/Lumber
as-ve—— No T
A -1 (A Lis s
Metals
C0
eo
Cardboard
Trash
W f4t - Not
N/A
Other (describe)
Required Documentation4: 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 proiect approval from the City.
I and my City -licensed hauler certify that the above materials from my construction site were recycled in the
volume / weight described and were taken to the facilities described.
/ he /J^
S ature (Con actor ner) D to
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