Meter Swap �_ -.... .
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N�►me �- c�- �.r�� �'' �:
Date L `c� �
Old Meter Number � ���
Old Meter Reading
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Replacement No.�3 �� ��=�-�f-��
Replacement Reading �
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Replacement Make�
Remarks:=�,.� � ����
Sign
ed t..� C�2%��`''�'
Request Number: 11608
Public Works Division
Service Request
Problem Address: 4531 2nd St Requested By:
Department: WATER � Adtiress: No address provided
Problem/Issue: INSTALL AMR METER Phone Number:
Scheduled Date: 2016-06-24 Scheduled Time:
ACTION NEEDED: i
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Created by: Wendy Hiatt Date Created: 2016-06-23
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ACTION TAI�N: ��.,�
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Status: In Progress Submitter Has Been �
Contacted
Date Completed: Completed by:
�/aY//�
. � - �iiy flf F�idley
- . . _ Irtla�e�C D��paPtettent _ .. _, ...._
64�1 Univ�rsity Avenue NE
frsdley,MN 55432
�953)572 356b
i(we her+�hy authorize t���tY of Frid6ey andjor F[�
employe+�to do what'is necessary to rep9ace the water meter.[understand that the prop�rty owner
_isllabl�for the water Dne firam the main tn the premise and atl inttereur p{umbing. (Per City cvde
402,��J t.als�fiold the CYy�f Fridtey andrts employees harmfQss +�e any amages t a may
while doir►g i�is c�+eratioo. This tv inctude,bu�nc9t I�mited tn;ualiresF p��ing,watis,fionr�or the curb
stap b+�x and servic�e linea 1 understand 9 am alsu required to ahtain a perrnit priart+o any wv+rk,if
necessery,
final meter reading�old meter}.�`-'� � �� `7'`'�
Name• Address:
�-�;31 �nd �f
Rh�sse Number: � Da#�: �� ...��--
Signa#�are:
Witn�ss 5ignaivice:
�RIDLEY C�TY��1DE _
CH,Q.P�F[4{iZ.Wi4�E&tr ST�RM WATER►AND SANtTARY SEW'ER
aDMIN1S'�RAI'4Ct�t
�Ref�rd�io�.�.3,454,5b5;56Sj 6Z9,638,5b�,9Z�,988,1�.44,1156,1191J
4i��.05.P�RMiT��E �
Prinr to canstruc�ing or repair of any water or sewer iine connec�ing the existing municipal system and any hause
ar huildingfor whir�the apg4icaiion is made,the owner or c�rrt�'acfar shail be requi�ed to abtain a petrni�forsuch
conrrectianJ and shalt pay a permi�fee as prouided in Ct�a�tec 11 ofthisck�de. After such cannection 6as 6een
made,the iAtater and Sewer Departrnent shall be nfliified. tt shal{6e unlawfui to caver any cannecting Gne ufiti�an
inspection has been made and such�annection and the work incid�t thereto has 6een apprflved bythe City as a
praperand sn4ta61e connectibn.
40�.06.�iEP�1R5 ANt3 N1AiNTENAf�CE TO�t71ti�1EC7'IQP!
-A�t�e-i€�itia�r+�n^pR's�n�+�<h��r rn�d�*t�the urater service curhstoo bflx arthe sewer(ead atthe prapert-
line or a water service or sewer lead has heen extended t�the p�opertYline f�r cannect�anr the apptica�t,owner,
or the occvpant or user af such premises shail be liable for ali�epairs required�o any water line and s�wer 1'mes
neces�ary for cannectian vf the premi�es from the main ta ttEe premises. If the prope�ty owner requests
rnainfienance service or repairs b�performed by t�+e C�ty,#he P�p�Y°'N�er shali be�harged far the co�ts of the
. meintenance and/or repairs, induding any ne�es�ary s�reet repairs,at a rate S�i annualfy by,an administrat3ve
paticy. it shall be the responsi6ilitY afthe aPP�icant,awner,accupantor user t�pe�fiorm st�andard maintenance af
� the sewer service line from the Prem+Ses t°�+e main including d�hris clearing or raot cutting and to maintain the
water seraic�cur6 stop 8ox far operability and at 5uch height as w�{ensuse that it remains a6ave the finished .
::,�,acte af tii�tand arpr��ty,�{R�6�5,�.���,_:Z.���:� _. ._ _ ..._ ._.:- �. . _ .:.._ .�.� �. --_- .:..� . =�-