HomeMy WebLinkAbout2821 DIXON CREEK CT - SPECIAL INSPECTIONS - 5/20/2021City of /~tColli~ 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 .j Field Verification Form JobSite ~B~l ~~Xo~ L~ C:.-C. PermitNo. 6'll 0 3~ L-f ~ Company Name A C.-C'o ~ Pl b. J:· t::t:5'· ~ City of Ft Collins Lie# MP-32i __ Rt:iplacement of Sewer line ~eplacement of Water line __ Add __ Replace gas line approx. ___ ft. (100 ft. maximum) approx. '20 ft. (100 ft. maximum) approx. ___ ft. ( 50 ft. maximum) Materialsused: c_,opp~ -;JP&-K Tested abl~'T fJ:tS.S, Lbs. for 30 minutes Installer Name (print~ ~ ,' ~ l AS-CR..o~ ~ • 1 ~ c-_~0-~{ Installer Signature_~--=----~-~-~----Date_---=-> __ ---'--'-------