HomeMy WebLinkAbout5151 BOARDWALK DR - A5 - SPECIAL INSPECTIONS - 8/21/2020/ ForfCollins ~
281 N College Ave; P.O. Box 580; Fort Collins, co 80522-05 80
Phone: 970 221 6760 FAX : 970 224 6134
Field V erifi cation Fo rm
JobSite ·~··· 5151 ~c VIZ. A 5 Permit No. 6210M0
Company Name 'fa/cl &!lu(LJ} ~~ M}/) /t:f ,£.. City of Ft Collins Uc# CJ ----
__ Replacement of Sewer line
__ Replacement of Water line
_){_Add __ Replace gas line
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Materials used: / d CSS +
approx. ___ ft . (100 ft. maximum)
approx. ___ ft. (100ft. maximum)
/5 ft. ( 50 ft. maximum)
Tested at ;;26 Lbs. f:r --minutes
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lnstaller Signature C Date e . .:JI -:;}<J;;?()