Meter Swap F2eq�t for �eruic� Ftepart
C�iy of Fridl�t
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REQUEST FOR SERVICE REPORT
CITY OF FRIDLEY
Reference No, G�,Cj Date: L'(�a�- ��
i13
Request Type: Entered By:
Department: Citizen Name:
Address: 5 1'�c� 10i� Phone Number:
�
Scheduled Date: Property Owner:
Location Details: Request Details:
Action Taken:
� � lJ '�I�VL'�-�- � ) `l��\�' 1V � OT � !"�N� \N �1 C��-L— . i V'��{\ e � .
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Responsible Person:
Approver:
Completion Date: ��a�� �� Citizen Notified:
��
• ��G,J ���� _ City of Fridley
,.���_ .
�i� �`�3C:3 . . -... Watpr Depardnent
t�-� � � ����i�, 6431 UniversitY Avenue NE .� - -- -� � -
,��-�� ,� Fridley,MN 55432
�Lw '��•.r e.������ (7b3)572 3566
L�t � � I/we hereby authorize the�1(sf�dley and/or ifs
employees to do wh�t i�necessary tu repiace the water meter,t u�err�ttand that the property owne�
_is_lia�l�far the water tine from the main to the premi�e and a9��rior piambing. (Per tity cade
A02.0�6) I.aiso hold the Caty of C�id1eY and/its employees harmless or any amaBes may "
while doing this operation. This to indude,but nat limited to;values�Piping,wafisr fioors or the curb
�tap brnc and sanrice line. I understand I am also required to a6tain a Penmit P�ar t+o any work,if
nece�ary.
Final meter reading�old meter) � ` � � � '
� /�C `, � ``�
Address• I�—? ���C,�V _ �t'
Name• , .
Phone Number• Date• � �✓� ( , ' .
Signature•
"'�'�''` Witn�ss Signature•
� FRIDLEY CITY CODE
CHpiPTER 402.WATER,5Tt3RM WATER,AN��4NCTARY SEWER
AaMlN15TRA71UN
(ltef Ord No 113,464,555;566,6�9,638,662,9Z2,988,1144,1156,1191}
4{�2.05.FERMR FEE �
Privr to canstructing or repair of any uueter or sewer line connecting the existing municipa{system and��tt�1 house
ar 6uilding f�or which the appiication is made,the owner or co�tractar shall be required to abtain a perrnit fpr 5uch
connectian.and shall pay a permit fes as provided in Chapte�11 ef this Cade. After such cannec�on has bee�i
made,the 1Nater and Sewer Departme�t shall be notified. it shaii 6e unlawful to caver any connecting iine unti)an
inspection has heen made and su�h connection and the work inade�rt thereto has 6een approved by the Cit�r as a
proper and suita6le connectian.
4a�.06.REPAIRS AND MAINTENANCE TO CdNNECt1QN
A���p��� .. . __�____,.,.,+�the water service cur6stao box nr the sewer lead at the pmpert'
line or a wat�r seNice or sewer lead has 6een extended to the propertyline far cunnection,the appt�cant,owner,
or the occupant or user of such premises shall be liable far all�epalrs required to any water fine and sewer fines
necessary for cannectinn of the premrf�e by�the C�Yto thR p���e�shall be chargedefor the costs of the
maintenance service or repairs 6e p thQ r°
. maintenance and/or repairs, including any ne��ssary street repairs,at a rate set aanua4ly by.an administrative
policy. It shail be the responsihi�itY ofthe applicant,owner,nccupantor user tn pecfornt Standard rnaintenante of
• the sewer service fine from the premises ta the main including da6ris dearing flr root cutting and to mairitain the
water 5ervic��curb stap box far operability and at 5uch height as w�ensure that it remains abave the finished .
. . _ ..
. _ . . ._.
<,.g�,acfe oft�ri�tar+d or�rbp�ty.�iR�63�,��5,_?���:� _. . .� .