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Old Meter Number �� $�Q �-
old Meter Reading ,��d 9
Replacement No. 3 ,�S�D�'J�`' � ,
Replacement Reading !�
Replacement Make_ �.�,�,�� _
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� Request Number: 6985
Public Works Division
Service Request
Problem Address: 820 66th Ave Requested By: Eileen Dale
Department: WA"fER Address: No address provided
Problemllssus: INSTALL METER(WA7ER) Phone Number: 763-502-1690
Scheduled Date: 2013- 9-19 heduled Time: 07:00:00
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ACTION NEEDED: 2013 AMR �
Created by: Wendy Hiatt Date Created: 2013-09-17
ACTION TAKEN:
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Status: In Progress Resident Contacted ❑
Date Completed: Completed by:
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. City of Fridley
Water Department
• ' � 6431 University Avenue NE
� Fridley,MN 55432
(763)572-3566
��We hereby authorize the City of Fridiey and/ar its oWner
employees to do what is necessary to replace the water meter. 1 understand that thP ProPe�e
is liable for the water line from the main to the premise and all inte�iar plumbing. ( '�Y
402.06) I also hoid the Gty of Fridiey andJits employees harmtess for any dama�es that may ouur
while doing this operation. This to inciude,but not limited to;valves,pipin�►���C�°Qy 1°o ke�c'u� .
stop box and service line. i understand I am aiso required to obtain a per�n p
necessary. ��
final meter reading(old meter) � �
Name� Address•
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Phorte Number: Date: ----
Signature: �
Witness Signature: �
FRIDLEY CITY C�DE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922.988,1144.1156,1191) _
402.05.PERMIT FEE -
Prio�to constnacting or repair of any water or 5ewer line connectingo shall ben eq�edto'b ain a pemirt for such
or buiiding for which the application is made,the owner or contrad
connection,and shall pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Wate�and Sewer Department shall be notified. it shall be unlawful to cover any�oved by he City as an
inspection has been made and such cnnnection and the work incident thereto has been app
proper and suitable connection.
402.06.REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at t I cant owner,
Iine or a water service or sewer lead has b�ea i��able for all repap s req r d to anY wa'ter�the and sewer lines
or the occupant or user of such premises s owner re uests
necessary for connecti�n of the premises from the main t{�e Pf aperty ow�ne shall be charged for he co5ts of the
maintenance senrice or repairs be performed by the City,
maintenance and/or repairs, including any necessary st e ft occu�rant or user to pe�fo m standa d ma ntenance of
policy. It shell be the responsibility of the applicant,ow , P
• the sewer service line from the premises to the main incle d�n ad w II ensure hat t emLains above the fi ished he
water service curb stop box for operability and at such h g
grade of the tand or property (Ref 638,1156,1191)