Meter Swap � Request Number: 14123
Public Works Division
Service Request
Problem Address: 6899 Channel Rd Reqaested By: A�rew Knight
��:�Departme�: WA1ER Addreas: No address p�ovided
Problem/Issue: INSTALL AMR METER P�ot�Number: 651-724-7991
Sc6ednled Date: 2017-03-23 Sckednled 1lme: 08:30:00
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AC7ION NEEDED:
Created by: Wendy Hi�t Date Created: 201'I-03-15
ACTION TAKEN:
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St�taa: In Progcess �" ���er H�Been r
Co�s�ted
DateCompleted: 3 -���_-�,� Completedby: ����
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9��ar� t�er�i�y authorize t�ae�'rty nf�redley arad/or its eanployQes to do w�at ds necee�sao
re�aoace td�e aurater met.er. I+�nclQrst�e�d Ld�at�t�ee�ro�aes�tp owner is liable for t:he�vaater 9in�from�t+e snain to�ae premise and all imerioe-
ptaerra�sieag. (Per�C'rty�ode�Q2.�6� �adsa�aoid t#1e�"rt1�of F�6dley and/"rts em�i�yees harmless�or ariy�damages t[�at rtaay�r�n6ile�loirag
o�aea��ation. 1'his�o�nclucEe,�u�roo�lisniteel ta yatyes,p�ping,wails,flocsrs�r�te xztrb sCo�&aox arad servece lis�e. In�ndersfiand!am aiso se
t�o�taira a gerrni��ae'sos to any�eror�,if�ecessary.
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�4ttd��e1ETER READlNG�o(ct meterj � �3 5 0�a J� � ��i� I
A�ame: 1' IL`��1+.� ��6 �'1�" Address— l.-l� V L 1 1J�1'"'�`.."V� �s -
Pi�one�{umber�– �� !– q�( � �^a3^ ��,
Stgnature Witness S"a�sature ��
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�Ref CBrd 6�0 213,454,565,�&6,6Z9,638,��2,�122,988,1�G44,1L56,1191}
4Q2.5 PERRifl3"FEE
Prior to constructing ar a�epair of ar�y water of sewer iirae connecting the existing rnuniapaJ system and arry hs�use vr buitdfr�g fo�arhicl�tl�e
appiicafiifln is made,the owner or confiractos shall be required ta ohtain a permifi for such�nnectiory and shall pay a permit#ee as proaidec
Chapfier 1�of this Code. After such connection has been made,the Water and Sewer Departmerrt�sa!!�e notified. Ft shail be untaarfu!to c�
ar�y connecting line u�i!an inspeciaon�►as been;made and such connection and the wor�c inaderrt thereto has 6eea approved by tEte C(ty as
proper and suitable sonneGaora.
�02.06 ftEPk�lR�AR{��(AINTEfYAp010E Ta CONNEC77aR(
A�er the tniCia!connection has been made 3�#he aaater serarice curb stop I�oec or the sewer lead at�(te property line or a water senrice Iead h
been extended to fihe property iine for conreection,fihe appficanrt,o�rner,or accuparrt ar a,�ser of such premises s(»a(1 be 1'�ai�e for a!1 repairs
�-equrre�t to ar►y water line and sewer tines necessary for connecCion of the premises from�he main to the�remises. lf the property o+rrner
requests mair�tenance serv�ce or repairs 6e perFormed by tf�e C'rty,the propert,y awner shail be charged for the�sts trf the mairtte�arn;e antt;
repairs,inctudirag necessary s�reet�epa�rs�a�����ualfy!a�an administra#ive policy, tt shal!be ti�e respansibit'rtyr o#the applicarrt,
owner,occu�arrt or user to perform standard mairrtenance of the sewer service line from the premises to the main andudcig debrls dearirig�
root cutCing ar�d to mairrtain#he water service curb sCop brnc for�perability and at such height as wili ensure t�hai it remains above the finishe
grade of fihe tand or oroperty. (Ref 638,1156,1191}
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City of Fridley
Water Denartment
Address �� 1 1 l�+'t�,'L.. ��
xame �,�� K,NiGN'7
Date �"3��� -
Old Meter Number � U�
Old Meter Reading � '
Replacement No. '�j �o� � t
Replacement Reading �
Replacement Make '
Remarks: �Tt.�� ( ''�'>�,
Signed