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HomeMy WebLinkAbout1007 BOLTZ ST - SPECIAL INSPECTIONS - 5/27/2021City of ~~tCollins --:::: . -------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 --. Job Site } C> 0 f I':) o J + 2-Company Name /+-/ l -'-"" ~L.. .... / , /Replacement of Sewer line __ Replacement of Water line __ Add __ Replace gas line Materials used: Pv C / L . .,.,_J..._, Tested at _______ Lbs. A-~ L_ _/ 1?...-.:;,"-•'--1.J <::.....-<c:'_ Permit No. B 2{ 0222-9 City of Ft Collins Lie# -----approx. /,;.. 0 ft. (100 ft. maximum) approx. ____ ft. (100 ft. maximum) approx. ____ ft. ( 50 ft. maximum) Y'--·\.~ t <..,.{.. I A for _____ minutes Installer Name (print) l/\ \.th;_ vs... { t \. \. i,.....;, ..J-. ,'v ...... L (,,-Installer Signature __ ~-l '-'---•.,.__-· ,..,. ~~--j ~ J Date <.;-2 7 -2 l . _ _.... . I 1'