Meter Swap ` Request Number: 11616
Public Works Division
Service Request
Problem Address: 4538 2 1/2 St Requested By:
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number:
Scheduled Date: 2016-06-24 Scheduled 13me:
ACITON NEEDED:
Created by: Wendy Hiatt Date Created: 2016-06-23
ACTION TAI�N:
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Status: In Progress 5ubmitter Has Been C;
Contacted
Date Completed: �/Z f,� /�/��� Completed by: �(� �'ell�,(�
� � �� �i
� ` - cA�y�f Fraaiey
- - - � 1�lat�r D��partanent ... . _: �.._
6431 Universi#y Avenu�NE
€ridley,MFf 55432
{763)572-356fi
!/ure hereby authariae the�tY 4f Fridley andjar i#.s
empioyees to do wh�t u nesessar�v ta replace the water meter,t►mder�tand that the pmp�rty owner
�liable far the water(ine from the main ta the premise and a!I ir�terear piumbing. (Fer Qty code _
402,Q�) I.als�finld fihe C�y uf�ridtey�nd j'�ts employees harmiessfor any amages___ maY ocra�r
while doing tfiis aper�t�on. �'ws to incluei�,but n�t tirnited in;walu�,piping,��s,flonrs or the cUrb
stnF b+on and service rne. t understand t am atso requ9red to ohfia�n a Permit t�r�iar ta any wo;'k,if
necessary,
Final m�ter reading(old meter) �J`���
, �-� 5 3� a. �'a S � .
Name• Address:
Ph�ne fVumber:, [ta#e� ��� ` � �
Sigrtature. �
Witroess 5ignatue�:
� �R1DLE�I C11Y C�DE
CHI�P�'EFt 4��=1NA'E'ER,5Ti7BN1 WATER,AA�l1D SANiTAi3Y S�R
A[}MlNlSTRATIOH
(Ref Drd No�.13,454,565;56fi,6Z9,638,562,922,988,1�.44,1155,1191)
4��.a5.PERMIT FEE �
Prior to can�trttcEing ar repair of any water or sewer tina cc�nnectingihe existing municipal system and any hause
ar huilding for which�e application is made,the owner or cantrac�t shall be requi�ed tfl abtain a permi�for such
canrrectian,and shall pay a permrt fee as prouided in Cfiapter�,1 of this CUde. After such conner�ion i�as been
made,the 1Alater and Sewer Department shali be notified. It shal(6e unlawful ta cavec any connect'sng i'u�e unti)an
inspectinn has beer�made and such cannection and the worlc incidertt thereta has 6een appraved by the[�ry as a
prnperand su'rtabie cor�nection. '
402.06.�EPA1R5 Ad�!?MAINTENAIVCE TO�ffN�tE�T1�JN �
-P,�r���-iAitia `- '- �a+^�1�V+18't�P SBTV�CB CUT�SktV�{]OX 4(�I'1�5t'W£C I28tI8t�18 QCQp2lf.�
line or a vuater service or sewer lead has been extended to the property line for cannectian,#he applicar�,owner,
or the occvpant qr user af such prem�ses shalt be liable for al(i'epai�required�ro any waker iine and sewe�fines
necessary for�onnectian af the premises from the mein ta the premise� If the prope�ty owner i�equests
rnaintenance senrice ar repairs 6e performed by the Cty,the properkY uwner shall be charged far tk►e co�is of the
_ maintenance and/ar repairs, incfuding anY necessary street repairs,at a rate set annualiy by.an admiri�trative
pali�cy. It shall be the responsihility ofthe aPP�i�antt°`�►n�rf accupentor user tn perForm standard rna9ntenance of
� the sewer service Gne from the premises to the main inciuding d�6�is clearing flr root cutting and Co mamtairi the
water�ervice cur5 s�op box'Fc�r apesaD+l►tY and at such height as w�i ansure fihat it rernains a6ave fhe finished
::,. -. . . ._ .. . .. . � � -�
grad"e of t�r��iand vr-prc�p��i.y,-iR�6 0,�.�,,5:��t�-�f�:� _. __ _ ._._ -