HomeMy WebLinkAbout3821 FULL MOON DR - SPECIAL INSPECTIONS - 3/19/2021City of /~tColli~ Community Development & Neigllborhood Services 281 N College Ave; P.O. Box sao; Fort Collins, co aos22..:·osso Phone: 970 221 6760 FAX: 970 224 6134. Field Verification Form Job Site 3<c0\ ~ Q\ \ rn~ 1)X \ \I:: Company Name '2:iD@ :\:\t (x:X\ f\E:1 i f) \ "2-Permit No. ~(D t ([j (.o (!)(p City of Ft Collins Lie# t-\-\9oC/:) __ Replacement of Sewer line approx. ___ ft. (100 ft. maximum) . ~acement of Water line approx. ___ ft. (100 ft. maximum) ~--·Replace gas line approx. cz_t> , ft. ( 50 fl. maximum) Materials used: '2.. o .\'.\ . ' \ 7... ~v\c. \,._ _ \,, • .... ._ \ ,VI{-G o.S· f \._ -ex , 'L ,;. \,w +-o~fs I J-z_ ~"'-<.. ~ 1 . ·1.... \ J-z_ l;{o~e tw,.e_ (._Ovv\P,Y-e,.s>lOV\_ -\--Z,t t.V\_C\ S 1 Tested at \ l? Lbs. \ for VJ O rrlfnutes Installer Name (print) 2-.cc~ R.v\.,~l,N\,u ><-€ "'-Installer Signature ~ ~ S { l 01 /-z-a z l Date _____ i _____ _ 3: ru -, _,_ I.O 0 I.O 6 ~ Ln .[ ::::, ill --J 0 ~ w 0 00 N m "Cl . ru lCl I'll