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Name � �`aa.+� ���y�SG�
Date ��f�
Old Meter Number / � � �� .3
. Old Meter Reading ��� / � �
Replacement No._ _� �-- (`j�j ��"l
Replacement Reading C�
Replacement Make ��.�[
Remarks: ,S <o �,,� �.y,tf.�
S igned
Request Number: 8198
Public Works Division
Service Request
Problem Address: 490 67th Avie NE Requested By: Patricia Carfson
Department: WATER Address: No address provided
Probleml�sue: INSTALLAMR METER Phone Number: 763-245-4871
Scheduled Date: 2014-06-25 Schedukd Time: 11:30:00
�T� �
ACTION NEEDED: Install AMR
Created by: Julie Horak Date Created: 2014-06-24
ACTION TAKEN:
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Status: In Progress Resident Contacted ❑
Date Completed: Completed by:
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- City of Fridiey
� --- Water Department . _... .
6431 University Avenue NE
Fridley,MN 55432
(763)57Z-3566
I/we hereby authorize the City of Fridley and/or its
employees to do what is necessary to replace the water meter, 1 understand that the property owner
is liable for the waterline from the main to the premise and all interior piumbing. (Per qty co�ie
4U2.06) i also hold the City of�ridley and/its employees harmless fo�any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walls,floors or the curb
stop box and service line. i understand 1 am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter), V � �� ��O
� ���- �Fut�
Name• Address:��_ -- ,
Phone Number• Date: lX^��� ��
5ignature: " � 1 '
Witness Signature:
FRIDLEY CITY CODE
CHAPTE 4 2.WATER,S70RM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144�,1156,1191)
402.05.PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and any house
or building for which the application is made,the owner or contractor shat{be required ta obtain a permit for such
connection,and shall pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shall be unlawFul ta cover any connecting line until an
inspection has been made and such connection and the work incident thereta has bee�approved by the City as a
proper and suitable connection.
402.06.REPAIRS AND MAINTENANCE TO CONNECTION
After the inftial connection has been made to the water service curb stop box or the sewer lead at the property
line or a water service or sewer lead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shali be liable for all repairs required to any water line and sewer lines
necessary for connection of the premises from the main to the premises. If the prop¢rty owner requests
maintenance service or repairs be performed by the City,the property owner shall be charged for the rnsts of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annually by an administrative
policy. it shatt be the responsibility of the applicant,owner,accupant or user to pe�form standard maintenance of
� the sewer service line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)