Meter Swap ti
� Request Number: 13625
Public works Division
Service Request
Problem Address: 6150 Briazdale Ct Requeated By: Donald Betzold
Department: WA1ER Address: No address grovided
Problem/Issue: INSTALL AMR ME1ER Phone Numbcr: 763-571-d098
Sehedulad Date: 2017-03-08 Schednled Tjme: 01:OO:OU
�
ACTION NEEDED:
Cre�ted by: Beth Kondrick Date Cra�ed: 2017-02-23
AC'IION TAI�N:
Statua: Tn Progress Sabmitter Hu Beon �.,
Contacted
Date Compieted: Completed by:
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ax^e.as agaeuv�n�xtij'e�'AY��J9.tl�0V�
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s 9J�°� here6y authorize ihe�C'rty uf�ridley and/or its employees�o do what ss necessary
. �eg�4ace the eerater metec. 1 vnderstand td�at�Fee q�ro�aea�ty�vner as liabie for the wrater Bine from ghe main fio�ihe premise and ail irnerior
plaaaraising. (Per C'rty code 4D2.06) 9 afso hof+d the�'rty�f�idley�ndJ'rts em�loyees hasmless for amy�iamages that rraay occur i,vhite�loing t
o�eration. Tfiis Yo�nclude,bu�not lian6teel�o valves,p�ping,wa(is,floors or�e cur&a sto�box and servece line_ !n understand i am aiso a�ec
tr�a�taira a persn'rt�ria�r to asey rror&,sf necessarv`.
�9r(a�.�1tETER ttEADt�1G(okt meter} �'��� l l�
Name: _ ki.JC�[/�, �vl �d Address Y�` � UJV? Q� '�i �i�
Phane�tumber�� ���" ��g Oate �'� V ✓ l 7
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Signafiure Wii�tnness Signature J
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OLD METER� �v�l ����'� ��
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OLD READtlIIG,,,., _ -v---1� � 0\�
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NEtAO MEtER# /�� D�f
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6798
FRMDL�YY�17�f C�D�
Ct�BA�'Et�d02.WAT�R,STOEiM WA�'E4Z�I,ND SRF[CCARY SEWER
ADMINISTRATtO�f
�itef Ord N�113,464,565,56&,629,638,562,922,988,i144,I1S6,1191}
�Q2.5 PERMIT fEE
Prior to constrarcting ar repair a#arry�rate�vF sewer line connecting the existing munidpat sysfem and any house oc f�,tifdingfor which#he
application is made,the awner or co,rtractor sha!!be required to obbin a perrr�it for such connedion,and shali pay a pemut fee as pro+rided
Chapter 12 of this Code. After sud�connecCion has been made,the Water ae�d Sewer Department shai!be natified. i�t shait be untawfuf tn ca
ar�y connecting 1➢ne urrti)an irrspectioa has 6een made and such conneckion and tfie wordc inader�t fihereto has iseen approved#ry yhe C'rty as a
proper and suitable connection.
�tf2.05 REPAlRS A�iD�IiA1NTENA{tiCE Ta Cf�I+AIECT'iflN
After the inifiiaf connection has been made to the water senrice curb stop box or the sewes lead at the property ifne or a water service lead(k
been Qxtended#o fihe property line for connectian,the appiicarrt,own�r,or accuparrt or user af such premises shal!be Iiabie for afl repairs
required ta any water line and sewer iirtes necessary#vr�nnedion of the premises ftom ihe main to the premises. !f the property�rr�er
requests mairrtenance service oc repairs be performed try the City,#ae property awster shail be charged for the tosts af the mairnenance and/
repairs,includirag necessary street repairs at a rate set annuaify by an administrative poi�cy. ft sba(1 he the responsbilFty ofitfie a�l�c�t,
owner,occuparrt oc user to perform standard mainte»ance of the se�wes sQrvice line from fihe premises to the main 3r�ctuding debris dearing o�
root cutting and to mairrtain Che water service curN stop box for operability and at such height as wiil ensure Chat st rerinains above the ftnishei
grade o#the land or properLy_ {Ref 635,1156,1191]
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�k•���� � • ' �� �.{;. �3 3^¢ � M.`..F
Dat� � 3 � ��
Old_MeterNumber � 3 s�_L��t
Old Meter Reading �S � ���
Replacement Na � �51 � �� "
Replacement Reading
Replacement Make �,� d'
Replacement ERT#
j. Remarks: �Qa � �e
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_ Signed