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Request Number: 7380
Public Works Division
Service Request
Problem A�ddress: 101 Sylvan Lane Requested By: Carol Jacobsen
Department: WATER A�ddresa: No address provided
Problemlissue: TURN WATER ON/OFF Phone Number: 763-486-7549
Scheduled Date: 201401-09 Scheduled Time: 03:15:00
ACTION NEEDED: Emergency water shut off. Leav�e key. "`"`""BILL**"*
Created by: Wendy Hiatt Date Created: 201401-09
ACTION TAKEN:
Shut off wateNleft key. installed AMR Old meter 35990045 Old readin : 222?�850 I�w meter#44921648 New reading: 0
ERT#3515994�
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Status: Completed Resident Contacted O
Date Completed: 201401-09 Completed by: Pete Gunderson
Hours
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Request Number: 7380
Public Works Division
Service Request
Problem/�dress: 101 Sylvan Lane Requested By: Carol Jacobsen
Department: WATER Address: I�b address provided
Problemlissue: TURN WATER OIVIOFF(WATER) Phone Number: 763-486-7549
Scheduled Date: 201401-09 Scheduled Time: 03:15:00
ACTION NEEDED: Emergency water shut off. Leav�e key. *"`**BILL""""
Created by: Wendy Hiatt Date Created: 2014-01-09
ACTION TAKEN: �.j_I��T O I"r CC�P�'�T�f�� `�`r` ' � � A�.�J �R���'��
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Status: In Progress Resident Contacted �
Date Completed: Completed by:
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. City of Fridley
Water Department
6a31 University Avenue NE
Fridley,MN 55432
(T63)572-3566
��We hereby authorize the City of Fridley and/or its oWner
employees to do what is necessary to replace tfie watec meter. 1 understand that the property
is liable for the water line from the main to the premise and ail inter�oan f dam'a�es that may�oaur
402.06) i also hold the City of Fridley and/its employees harmtessfo 'Yln Walls,floors or the curb
whife daing tfiis operation. This to inciude,6ut not limited to;valves,p'p g�
stop box and service line. I understand I am also required to obtain a permit priar to any work,if
necessary. � ���
Final meter reading(old meter� ���
Names.,�--�ti t,,._ � - � 4�ri-.A��ress:�� ,
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Phone Number� , ` ` Date:
�1``j7` S" (` C"C Z;�1 .��''�`�'`
�� V(`�(r�� Slgnature: _.__
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�/�(��C.s'� Witness Signature:
FRIDLEY CITY CODE
����, � ��� CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION �
(Ref Ord No 113,464,565,566,629,638,662,922.988,114A�,1156,1191) _
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'"?����� �� 402.05.PERMIT FEE - house .
Prior to constructing or repair of any watedef the ow'ner orcont cto shall be equ redto'b ain a permit for suck+
or bw i di n g f o r w h i c h t h e a p p l i c a t i o n i s m a ,
connection,and shalf pay a permit fe ent shall�be not f ed.tlt shall be u lawful to cover an yconne icti g line untii an
made,the Water and Sewer Departm roved by the City as a
inspection has been made and such connection and the work incident thereto has been app
proper and suitable connection.
402.06.REPAIRS AND MAINTENANCE�TO CONNECTION
After the initiai connection has been made to the water service�o�e�0pine for connect on'the appf cantpowner,
line or a water service or sewer lead has been extended to the p p �V
or the occupant or user of such premises shafl bhe'main to the p e'mises.ulf he p operty ownerrequests r��nes
necessary far connectian of the premises from
maintenance service or repairs be performed by the City,the property owner shali be charge an admi istrati ethe
maintenance and/or repairs, including any necessary street repairs,at a rate set Qrf���sta�dard maintenance of
policy. It shali be the responsibility of the applicant,owner,occupant or user to p
• the sewer senrice line from the premises to the main indud�n ad w,ll ensure hat t m ns abo e the fin shed he
water senrice curb stop box for operahility and at such he g :�:
grade of the iand or property. (Ref 638,1156,1191) ,?..
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