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Date �j�$.._� c�.
Old Meter Number �30 ��� ��
SJld Meter Reading � � / ��7f�'
Replacement No. �` ���..5���'1� T
Replacement Reading �
Replacement Make �
Remarks: �j�ra7D�� l'�'Yr�-7`�`�''"
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S igned �''r`'-,—_'"
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<� Request Number: 11174 �„'
Public Works Division
Serviee Request
Problem Address: 5477 E Brermer Pass Requested By: Deborah DeBruz.�i
Department: WA1ER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 763-843-1167
Schedul�l I�te: 2016-02-08 SchedWed Time: �!�dr94
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ACTION NEEDED:AMR
Created by: Wendy Hiatt Date Created: 2016-02-08
ACTION TAI�N:
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Status: In Progress Resident Contacted ❑ � �;
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Date Cumpleted: 2/� /C� Completed by: �,�
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` - City of Fridley
- . . -. .., WatPr D+�partment
6431 University Avenue N� 4
Fridley,MN 55432
(7G3)57Z 3566
�/we 6ereby authori�e the�Y uf fridley and/or its
employees to do what is necessary tb repiace the water meter.�u��nd that the property owner
is liaat�for the water tine frvm the main to the premise and a�a��rior plumbing. (Per Ciiy code _
A02.Q6) l.atso bold the City of Fr�dley andJits employees harml�ss r anY amages may
while daing this operation. This tv indude,but not limited to;ual+re��PiPi�g,walis►�oors a�r the curb
stap box and service line. !understand I am atsa required to ahtain a permit priac t�v any work,if
necessary.
. �inal m�ter reading(oid ter� ������ �
� ;_ �� �,, �,��
Name: 7� Address:, `��_����"� s
P6one Number• - Date� � — g'�r2---
� ,
SigrteEure•
Witness Signature� �
FRIRLEY CI7Y CODE .
CHAPi'ER 4�2.WATER�STORM WA3ERr ANU SANCfARY SEW�R
ADMfNISTRATitfN
{Ref t]rd I�o 113,464,565;566,6Z9,638,662,922,988,1144,1�56,1591�
40Z.05.RERMIT�EE �
Prior to tonstructing or repair of any water ar sewer line connectingthe existing municipa(system and any hause
nr huilding for which the application is made,the owner or enntractur shall be required ta obtain a permi�for such
canrrectian,and shall pay a permit fee as pravided in Chapte�11 nf this Cade. After such cannection 6as been
made,the iNater and Sewer DePartment shal{be�atified. lt shali 6e unlauvfui ta cover any conne�ting line until an
lnspection has 6een made and such cannecCion and the work incident thereto has 6een approved by the City as a
prnper and suita6ie connection.
402.06.REPAIRS AND MAINTENANCE TO CONNECTI�M
�__�___.�..,�..+��y�,����service curhstoa bax arthe seurec lead et the propert�
��-iai�ial_tanqer'zwnnas
line or a water seNice or sewer lead has been extended ta the propertyline for cannechan,the apptic�nt,ownec,
or the octupant or user of such premise5 shall be liabie for alI�epai�required to any water iine and sewer lines
necessary for connectian of the premises from the main#o the premises. if the prop�tty owner requests
rnaintenance service or repairs 6e performed hy the qty,the property uwner shall be charged for the cnsts af the
. malntenance and/or repairs, including any necessary street repaia,at a rate set aanuaAy by�n admin4strativve
palicy. It shall be ifie responsibility of the applicant,awner,occupant or user ta perfarm stand'ard maintenanc�of
• the sewer servic�line from�tte prernises to the m�in including de6ris clearing nr raot cutting and to maintairi the
water�ervSc��cur6 stop boxfor operability and at 5uth height a5 w�ensure that it rema(ns abave the�inished .
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