HomeMy WebLinkAbout1130 OAK LEAF CT - 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
JobSite 1130 OA:ll, r@f GT Permit No. 13 2 / D 2~9;,
City of Ft Collins Lie# Mf-l-/ Company Name ,4 U.£tv $e'nV!U::
__ Replacement of Sewer line
_£_ Replacement of Water line
__ Add __ Replace gas line
Materials used: 3/tt" 'i?tX
approx. ___ ft. (100 ft. maximum)
approx. '-10 ft. (100 ft. maximum)
approx. ___ ft. ( 50 ft. maximum)
Tested at ______ Lbs. for ___ minutes
Installer Name (print) ,/11/k,,G &{!V(7rL..
lnstallerSignature ~~ Date ___,~+-*=~=--,...c@_'!J"? __ ( __