HomeMy WebLinkAbout2056 BENNINGTON CIR - SPECIAL INSPECTIONS - 3/9/2021City of
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Community De velopment & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, co 80522·0580
Phone : 970 221 6760 FAX: 970 224 6134
./ Field Ver ifi cation Fo rm
1..,6.GCo 8t/JNIN6T9N C.1RCLE PermitNo._....,f3~1..._,_o_,_l-/_7_(p_ Job Site
Company Name Ki.Jr.µ-fU&Y1hi1J fJ/abiij 1 /11.t-. CityofFtCollinslic# 01/?·-/3/
_ Replacement of Sewer line approx. ___ ft. (100 ft. maximum)
__ Replacement of Water line
.-4-Add __ Replace gas line
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Materials used: 1/:;'_, .O tA CK
7
Tested at /0 Lbs.
approx. ___ ft. (100 ft. maximum)
approx.~ ft. ( 50 ft. maximum)
Pl .PE
for :Z,.(} minutes
Installer Name (print)-<Je€!,_..~-:~~~=--=s,-.h ....... «:~----
lnstaiier Signature _ _._Q_ ___ +._,--,,,~=.....,-~-----Date--.c3cc.-/L.........<...;9 /_J.o_:Z._{_