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REQUEST FOR SERVICE REPORT
CITY OF FRIDLEY
Reference No. I��� Date: .,
1 �
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Request Type: � Entered By:
Department: �� Citizen Name:
Address: ����- �� �� Phone Number:
Scheduled Date: Property Owner:
Location Details: Request Details:
Action Taken:
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Responsible Person: "
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Approver:
Completion Date: C3 G� �� Citizen Noti�ed:
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��''�� �aereb�acathmr9ze the�fiy af�ridiey aa�eiJar its�rn�a��yees�o do vrF�at as�aecessar�
''��t������'�'���'�e��a�- ��ae�st�rstand ttaae the�ropert��o�nea�is iiable for�he water line�s^am�e nraaiea tu the pr�rt�tise and att�ertQnior
�iszcssbinge �Per City u�de 3��.dl6� !aiso#ao8d�he�t�y af�r�dtey a�ad,�its emgloyees harQn4ess fos arsy dass�ages�'hat�na�occur yvlaile doing�
a��ee-�tiQn. "�is�s�in�cxde,�Se�t sacrt�imite�to v�alves,pipin��valls,f9oors or the csaris stap box a�ad seavice 9ine. �n undersWnd i arn als��ec
to a�tain�pec�nait�Sr6or�o any w�ortc,if�ec.�ssary.
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� Pr6ar to consi:ructing�r repair of any water af s�n►er tine connecting the existin�muntcipa{system and arry hause or buiiriing.for which the
a�aplication is rnacie,the vwner or correractor shalt be reqaired tcs abtain a permit for such conRectior+,and shaii�ay a�ermit fee as provicted
�hapter 11 of this�s�de. Ai`�er such connection has taeen made,�he Water and�ewer�3epartmerrt shait�e nvtified. �t sha(d be vralaarfvi to cc
an�coranecting 4ine unt6!3n ins�ection has�Seen made and such corsnectian and the�rrortc incident tt►ereta has�een approved by the City as�
�sroper and suitab(e�nrtection.
Q�02.@6 �tEPAtRS A.Vm�e1A4t�44'8'EE+IAt�ICE���NiVECTiON
After tfee�nifivai zonnectiort has been rrtade to the water secvice aarb stop f�vx ar tFae seuv�r lead xC tiie�cvperty line or a ura�Cer serv�ce tead h:
been extended to the�roperty line for cannection,the appiicarrt,owner,or occuparrt�r user of such premises shall he liab(e t�cir atl repairs
s�equirec!to aray w�ter 4ine arad se�ver{ines necessary For connectiort of ti�e preenises from the maon t�ihe�remises. tf the properry overner
requests mairnenance senrice or repairs be perFarsneri by the C�ty,the rsraperty owrter shal!be charged for the casts of the mairttenance and1
repairs,including necessary street re�airs at a rate set annuai(y�y an administrat'sve poiicy. 4t sha([be the responsibility of the appiicant,
ouvner,occupan�t or user to�erform standarsi mairrtenance of the se+nrer service licre from the�remises to the main tnctudeng slebris ctearing a
�-sao��uttirtg aa�d to�nasntain the water;erv�ce curb stop box For operahitity and at such height as wili�nsure that ifi�mains above the finishe
g�ade of fihe tand or�eroperky- �92�f 638,�956,3,19�)