HomeMy WebLinkAbout3019 PLEASANT VALLEY RD - SPECIAL INSPECTIONS - 5/6/2021..-----------
Community Development & Neighborhood· Services
281 N College Ave ; P.O . Box 580; Fort Co ll ins, CO 80522 -0580
Phone : 970 221 676 0 FAX : 970 224 6134
Fie ld Verification Form
Job Site 3019 Plecoa()f Vall c:-y l!d. r Perm it No . !3 d(J/ c2 ¥l-?
C ompany Name lt/orther() &!ct&l12 l½1rnii io9 f JJ/cul"J City of Ft Colli ns Lie# _____ _
__ Rep lacement of Sewer line
.¼-Replac ement of Wa ter line
__ Add __ Rep lace gas line
app rox . ___ ft . (100 ft . maximum)
approx. 1./o ~lp ft . (100 ft . maximum)
approx. ___ ft. ( 50 ft . maximum )
Materials used: -..L....>c:.+:e........ ___________________________ _
Tested at Ml() {)Uff;t1f',::,,-4--L~s. for
' Installer Name (pri nt) -M,i-:det2 rieh 5eN
Installer Signature ~ #0<,-__.-• D ate .S f~/ '2--I
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