Meter Swap °� Request Number: 13926
Public Works I)ivision
Service Request
Problem Addreaa: 6610 Channel Rd Requested By: Carolyn Pcrron
Ds�rt�e�: WATER Adireaa: 6610 Ch�nel Rd
Fridiey,MN 55432
Problero/Issue: INSTALL AMR METER PLoee Number: 612-987-3916
Sc6eduled Date: 2017-03-13 � Sehedaled 11me: 11:00:00
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AClION NEEDED:
Crc�ed by: Beth Kondtick Date Creatad: 2017-03-08
ACTION TAI�N:
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Statua: In Pro ss ��her Haa Been r
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Date Compietedc Coe�pleted by:
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iaer'�6y au�o�ize�ae�i�o#�ri�de�arac!/�r its e�pdvepaes�o aio aw�at ss nes�
��o�ace�fie�er rs�ae�es. �uaac�erstaaed t�gtae�erogaes�onvnes�is diaksle f�r�oe wvatar 6iea�from the anais�to�ee�oremise and adl iaiter
,taa�rsd�ieag. (9�e��C'rty�ode�II2.06� �adso�So9d the�"r2tf+Sf�idley and��ts�rrog�lixye�s har�mless for amy slamages�aat saaa��cc�xr w9aile�lc
��SeeatSor�_ �'�a5s��n�I�cF�,��vcat�8aaas�eci�o rralves,�3l�?il't�',aaat(s,��ars�r�e�ce�da stog��aox arnd seavece�isee. lea�eesd�rstanrt�am aL
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Aee�i��ar"so��v aray�er�e-�,af ssecessara�.
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Prior to cvns�ructing or repair of a�ry�rater vf s�ves 9ieae connec�i�tg the prcis#ing arntniapai sys#em and arry�t�se or l,�iIding for nrhidt�
applicatifln is made,the awnes or co,rtract�r shaii 6e�qu�red to obtairs a Qermit for such connectiori,and si�ali pay a permr�fee as prwi
Cha�rter Y�of this Code. After such cororection has been made,the�It'ater and Sewer DeparCmertt shaU be not'rEied. Ft sha11 be uniawful#
ar�y cona�sctang dine unia7 an inspectian f�as been anade and such connectivn anci the wor�c inaderrt theretv has beera aPFi'aeed by i�re Cifiy
proper and sc�itabte connec�iora.
402.D6 9iEP,�lRS eatEttB�ri�(�T'E*tANCE TtJ CONN�CTi{i44t
�er the�ni#ial conneetion has�eera made�v the rvater service curh stoP boec or fiFse sewer tead at�ise i�roPet't�f�ine or a irater senrice�
beera extensied to the prope+-tq'line for conreectaar�,tF►e appiir.arrt,oumer,or aecu�ar�t ar axser of such premises shaIi be ltahle far al!repair.
reqaire�!to arry water lirre and sewer l�rres necessary#ar connectian of�iae p�-emr'.ses from the main to the premises. !f the praperty owne�
e�equests mair�tenance service ar req�airs be perFormed fry�he C'rty,tfae�rrope►-f,y awner shatl be d�erged for the�o#t6e mainterrance�a
repairs,inde�disag ne+�essary�reet repairs at a rafie set annuaJly�arr adrninrstra+�tiire pv�icy. tt sfiatf be fihe respans�itity vf the a�i'icarrt,
m,vner,occuparrt�r user to perform standard anairrtertance of the sewer serwice line frorri tYse premises fio the nnain�ndutiirig,detm�deari�;
raat���tCing and�o mairrtain the water servi+ce curb sCop bvx for o�aerability anot at such iteigFrt as wr'fi errsure that iC riemains above the fini:
grad e of�khe land or�troperiY- (13ef 538,1156,13�92�
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City of Fridley
Nater Department
Address ��J� ���,�
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Name �.Ar�y ��1ZS�•1
Date �T'`��(� � �� �
� Old Meter Number ���� �j�� _
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Old Meter Reading o�
Replacement No. ���55�
Replacement .Reading �
Replacement Make��
Remarks: _ C)LO`L.Eq�'.�/ /V1��'C�,_
Signed �