HomeMy WebLinkAbout612 LOUISE LN - SPECIAL INSPECTIONS - 4/3/2018I
City of
ort Collins
Job S
Company N
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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
Permit N�o
City of Ft Collins Lic# • �T 0
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ant of Sewer line approx ft. (100 ft maximum)
ant of Water line approx ft. (100 ft. maximum)
Replace gas line approx 1 ft (50 ft maximum)
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Tested at 5 Lbs for 30 a minutes
Installer Name (print) VOiCAOC t �C�YYI�OsOY)
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Installer Signaturdz���^-�� � 'r
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Date jq'13 '/-z61 6