Meter Swap 5
` Request Number: 10039
Public Works Division
Service Request
Problem Address: 5373 Sth St Requested By:
Dep�rtment: WATER Address: No address provided
Problem/Issue: WATER SERVICE LEAK Ph�ne Number:
Scheduled Date: Scheduled 1lme:
ACTION NEEDED:Water service line.
Created by: Wendy Hiatt Date Created: 2015-OS-04
ACTION TAI�N:
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Status: in Progress Resident Contacted �
Date Completed: Completed by:
R�quest far Service �Repor� �
4 � C;ity �f Fti�ile�
RefercncE Na: , �ate: �.,�-i�
Hcquext Typre_ Entered By� -
Oeaarkment: �itizen Name: ��1� ���'�����
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Adt�ess_ ����`� �J � �� S � Callback Pho►�e: �l�-a 1� - p��� �
Sched�ed Da�e: Property Owner.
Location Deta�s: Raqu�st i�atals:
ActionTakan: _._...__�_.__-_ ..---_�_._.__.....—•--.,
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Fiesponsihie Petson�
Approver.
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_ _..._ ___..._._....__.....__..__ _.. �C.ikixen Noti�ad
Gamplet�on D ate: � 1
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_ w City of Fridley _ ,
�` Water Department
6431 University Avenue NE
' Fridley MN 55432
, . (763) 572-3561
Uwe hereby authorize the City of Fridley and/or its
employees to do what is necessary to shut offthe water at the curb stop box. I understand
that the property owner is liable for the water li.ne from the main to the premise. (Per
City code 402.0� I also hold the City of Fridley and/or its employees harmless for any
damages that may occur wlule doing this operation. This to in.clude,but not limited to,
sod, yazd,landscaping,trees, shrubs,driveways,sidewalks or the curb stop bax and
service line. I un.derstan.d I am alsa required to abtain a pezmit prior to an.y work.
� -� ���15�- 5��� ' ���
Name:� �z� �vs��.�r ry�� Address:
Phone Number:��C�--7�7 7_S' Date: ��� � �
Sign.a.ture;�_____,l`? � �
Witness Signature:
FRif}LEY C1TY CODE
CHAPTER 4Q2.WATER,5TORM WATER AND SANTTARY SEWER
ADMIlYISTRATION
(Ref Ord.No 113,464,565,566,629,638,fi62,922,988,1144,1156,1191)
402.05. PERMIT F'EE
Prior to constructing or repair of any water ar sewer line connecting the existing municipal system and any
house or bwilding for which the application is made,the owner ar contractor shall be required to obtain a
pemut for such connection,and shall pay a.permit fee as provided in Chapter 11 of this Code. After such
conneetion has heen made,the Water and S�wer Deparlment shall be notified. It shall be unlawfiil to cover
any connectin.g line until azt inspection has been made and such connection a�id the work incident t3�ereto
has been agproved by the City as a proper and s►ritable connection.
402.06. REPAIl2S AND MAINTEN.ANCE TU CONNECTIUN
Aftar the initial connection has been made to the water service ci�b stog b�ox or tb.e sewer lead at the
properiy line or a water service or sewer lead has been extended to the property line for co�.e�tion,the
applicant,owner,or the occupant or user of such premises shall be liable for all repaits requued to any
water lin:e and any sewer lines necessary for connection of the prenoises from the main.tn ti�e premises. If
the property owner requests maintenance services or repairs be performed by the City,the property owner
shall.be charged for the costs of the maintenauce a�nd/or repaixs,including any necessary street rePairs,at a
rate set annually by an administrative policy. It shall be the responsbility of t�e applicmrt,owner,occ�aut
or user to'perform standard maintenance of the sewer service line from the premises to the main including
debris clearing or roat cutting and to maintam the water ssrvics curb stop box for operab�7ity and at such
height as will ensure tb.at it remains abo�c!e�e finished grade ofthe land or properiy: (R.ef 638,1156,].191j