HomeMy WebLinkAbout403 FRANKLIN ST - SPECIAL INSPECTIONS - 7/26/2021City of
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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 4o~ fl2.AiYk-1.1 !IV sr Permit No. 1S2 /() 2 {p ?7
Company Name A-U,f,V G€1Lvtc£ City of Ft Collins Lie# tL{f-l /
.)s,__ Replacement of sewer line
__ Replacement of Water line
__ Add __ Replace gas line
Materials used: l( Pv L I t/ 11
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approx. ~ ft. (100 ft. maximum)
approx. ___ ft. (100 ft. maximum)
approx. ___ ft. ( 50 ft. maximum)
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Tested at _______ Lbs. for ____ minutes
Installer Name (print) .tt/< Ct,,€ (}l [ V~
lnstallerSignature ~~~ Date -7.{__2C, fz_.ozv
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