HomeMy WebLinkAbout2424 ARCTIC FOX DR - SPECIAL INSPECTIONS - 9/22/2021hCityof ~tColl1ns .......___ 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 Job Site 2 lf :JV /}l.circ /!o rx W, v£-Permit N~. VBJ lo 6 rS/ Company Name &a~ r?lifm,l"'l"v'9 /LC-CityofFtCollinsLic# /Y)/J S-30-7 l · _ Replacement of Sewer line approx. ___ ft. (100 ft. maximum) _ Replacement of Water line approx. ___ ft. (100 ft. maximum) _ Add __ Replace gas line approx. ___ ft. ( 50 ft. maximum) Materials used: ,df.o//{f ~t fr1(! f µ7J/t-rr Y~CY kr '3/ Tested at /fa_; (6-~f--Lbs. for /-« minutes fJy ti--fw f c-s(fv&-P l ,m~ , ~ , b '/1 j), CJO /<ju J ~ I Installer Name (print) ,ffek{:-Srnlltf·-ot--IIV"6r /hoN<F-/' V/"11-7 /i I lnstallerSignature~~ Date ~J.2:_-;?-[ I I I I ' I I I I l I