HomeMy WebLinkAbout713 MARIGOLD LN - SPECIAL INSPECTIONS - 7/6/2021Community Development & Neighborhood services 281 N College Ave; P.O. Box 580; Fort Collins, CO 8052'-2-0580 Phone; 970 221 6760 FAX; 970 224 6134 Field Verification Form Jab Site --11 5 .f)JB:ri{.-wld 1-a~c Company Name /l .. {yf h ~~r-tJ /'b;£JJ/t{do J?{uoiJ,, of/ i iJra In Permit No. ./3 Ji t O J..J (,p 19 City of Fl Collins i.ic# __ /YIP · 5 7,9 __ Replacement o( Sewer line -t-Replacement of Water line approx. ___ ft /100 ft maximum) -·~Add ___ Replace gas: line approx. L(; C ft. (100 ft. maximum) approx .. ·-·----·-· ft. ( 50 ft. maximum) Matenals used.~~-\(-(c:.~vz-y:---··---··-·--·-·----~~··· .. ··-~-,.....:;r.A \.--,.•--:"r' Tested at v,.,~\'\.-\\r.~y:'t'~ for _,1;-_·_ \ ,,,ir,u~os lr:sta!!er Name (print) Lx1:" '\~. \~,y'\ Q{.,1l_>~---____ _ Installer Signature_-4,.1£~~-___________ _