HomeMy WebLinkAbout5436 HILLDALE CT - SPECIAL INSPECTIONS - 5/24/2021~ort Collins --~ 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 Fceld Verification Form Job Site Q!il_ ~ dz//c(ale C!'--7 ' Permit No. L:2 ,;2/0,.1.225 Company Name Afe21f6c.rz! t'daeOab />iuimbt/Jt:j 1:' V a.i:/J City of Ft Collins Lie# /f)/J-:5 7 '7 __ Replacement of Sewer line L Replacement of Waterline approx. ___ ft. (100 ft. maximum) approx. ___ ft. (100 ft. maximum) ______ Add __ Replace gas line approx. ____ fi. ( 50 ft. maximum) Malenals used: -5/4 t-.._C(i~---------------------Tested at /:1:1::., oV Lbs. for .;;i;L?/;:{,utes lnslalle,Name(printl\~ ~-Ac Installer Signature ff.fl/( t~-:::.:::::.-' ... .....,,. Date ,:;/;qJ/ Z/-~----~u:y;er-) (chbeo,)