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Request Number: 16668
Pub6c Works Division
Service Request
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Problem Address: 4827 2 1/2 Street NE Requested By: Deloris Vlieger
Department: WATER Address: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 763-572-8827
Scheduled D�te: ��15 SchedWed 1]me: � .
ACTION NEEDED:Install AMR
• Created by: Jeazmie Benson Date Created: 2017-08-10
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ACTION TAKEN:
,� ................:....OLD...:._METER......NUMBER_;...................................�� � I� ���,�5• �.�
OLD METER READING:
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NEW METER NUMBER:
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NEW METER READING:
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Status: In Progress Submitter Has Been r
Contacted
Date Completed: � ��� � '� Completedby:
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�'�''v� herafor�a�athor9ze Che�tt+�af�s�sdiey ancl�'�r its�rn�ia•�ees�o d��v&�at is�aecessar�
�e�iaca�he uvater naeter. �urad�rstand Cl�at the�ae��er�uwne�as�iai�le far tiae yvater line fr�ava�he rnairt ta the�rQsreise and a81�e�ter9or
�da�rra�aing, {Per�ity casie 4P9�.�6) !a�so iaaid the��.rnf Fric!{ey arasd�'its empi�yees�aarmless for am/daea�oages�fiat�nay occur while daing t
�gser�t9on. "9'his*��nda�de,be�t�aat lirn°rCed�o vaives,�i�Oin��valts,f�oors�r trse curi�sto�O box�nd serx+ica 1ine. dn undeastand 9 arn also�ac
t�o�tain a�aea�rait�acaor�o a►�ay w�orfc,'sf�ecessary.
�9PIs�11Rk"�'�St RE��AiG�Qict meter�-- � l l!� v �
Name: '� �1' (� � I)� Y �4ddr�s,s V � 1�2 ��• ��
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`�Signature W�ness Sigrtature '� —
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4Q2.S d�E�ZMiT FEE
� P�ior to constructing or��air�f any water of se�►er lins cannecting the existirtg rnunicipaf system and arty house er buitdirtg for ur6ich the
apuiication is�nade,the ovvner�r caritrar�ctor shait be required to a6taira a permi�for sucF�cortnect�on,and shaN pay a�rermit fee as provided
Lhaptea�13.�f thPs�r�de. Afte�such connecCion has�een made,tiae Water and Sewer�3epartmerrt sHait be noti�iecf. !fi shafl be�nlauvful to cc
an�connecting line urrCi[an inspection has been made and such corsreection and ti�e aeror!c incideret i�ereto kas been approved by the City as:
�ro�aer and suitable cxaanectiort.
4Q2.�6 �tEPAtltS A,�t�MpliNT�3VANCE T��tDNNEC9'iQN
After t�ee initiai connection has been made to the�rater service ci,trb stop�ox ar tEae sewer lead xC tf�e prvperty line or a uvarter sen�Pce tead h;
#�een extended to the�roperty line for connection,the appli+carrt,oamer,or accuparrt ar user of such premises shal{he liabte for ail repairs
required ta any water line and seMrer lines necessary for connection of the,�remises fram the main to fihe premises, tf the property owaer
c�guests mairrtenance senr�ce or repairs be performed by the�ty,Che property owner shail be charged for the casts af the mairitenance ar�d�
re�airs,inciuding necessary street repairs at a rate set annuaity ay an administrative�oiicy. It sha(I be the responsibility af Che applicar�t,
owner,occugant or user to perform standard rr�airrtenance of the sewer servise line Fs-orr�the�remises to+the main inciuding debris dearirtg a
rsao#cutting and to mairrtain tiae u�ater serv�ce cur►a stop box for o�er'a�il'rty and at such height as wilt ensure�hat it remairu abrnre�:he�Snishe
grade of�he iand or propert�/. �Ref 538,1956.1191�