HomeMy WebLinkAbout4392 STONERIDGE DR - SPECIAL INSPECTIONS - 5/24/2021City of JFort 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 Field Verifacation Form /4;0~) ( Ld,r~ Job Site // ,;l. 1/ .2 ,;5~ M &fd9J Permit No. /lJ P· 1' 1-:!/ ff~ /0/f'2 f Company Name li/g-/f;erf] &!orOL:& P/am..6,o<J ; L)~/ City of Ft Collins Lie# /YJ/J.,.. .5 79_ __ Replacement of Sewer line . approx. ____ ft. ( 100 ft. maximum) -1(_ Replacement of Water line approx. ____ ft. (100 ft. maximum) __ Add __ Replace .. gasz approx. . . ft. ( 50 ft. maximum) Materials used: ~;)_ -~ r:w L Tested at ________ Lbs. for ~----minutes Installer Name (print) }Ll'J2 ~<?;£\,,=--= Installer Signature Jfed ,4 [~ ....:.....:..:. .. .. ,. Date d2/lf;21