Meter Swap � ' Request Number: 14083
Public Works Division �
Service Request
Problem.�ldress: 1341 Creek Pazk Ln Reqnested By: Russell
Department: WATER Addre:s: No adstress p�ovided
' ProWem/Lssue: INSTALLAMRMETER PhoneNumber: 5�1-4423
Schedale e: 2017-03-24 � Scheduled'Rme: 01:30:00
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ACIION NEEDED:
Creatcd by: Wend}+Hiatt Date Created: 2017-03-14
ACTION TAI�N: �
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Status: 1n Pro ess Submitter Has Been r
� Coetacted
Date Com�deted: Completed by:
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9,�a� here°�y autho�ize ti�e�'rty�f Frst�ley asadf or its employees#o cto�nr�at ds nece�
�e�9ace�e�erater�raetec. �+usaclerstaeed td�at�€ae g�rogae�y oarner is�iable f���lae�rafier line from�he anain to fi�e premase acid�11 interio
�tvs�s�s�ing. �Qr�C'rty s�e 4�2.Q6� �alsca�tmid�e�'r2�j�f�sidle�aod�afis em�l�,��s haemless�or any�amages�taat sraay�ccur�u4aite�la9r
� � �g�ee�t6o�a. i'4afs�o�nelucl�,bu�reo�1iaa�sted tc�walwes,�lF�ra�uralls,f9oors or�ae�ur�sto��ox and seavice lis�e_ Ira unders4nd�am also
' fica o8a#aiea a gerani�gar"sos to arny�nr�,'sf�ecessara�s
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�5'RfAL�MIETER t�EADlAYC�otct meter� `/� ��� <JL,/ �n � �,�'�./� �
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�gnature
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CEiAP�'�i�4�2.lh�A7'E�,S9'OI�lIi!W�I,TE4��l�i�S�t91f RAt3Y SEWEI�
ADQP!!R!i5�'�CATi�i�t
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402.s PEtii�(!�'FEE
�rior to constructing or sepair of ar�y�rafier of sesver�+ae connectang the existang rnuniapat system and arry tuiuse or'�7ding for which#hE
�FPlicafiion is made,the owner or cvrrtractor sha11 be required t�o obtain a permit for such connedion,and siaall pay a permit fee as provid�
Cha�ster 1�of�as Code. After sucti connection has�een rnade,#he�Vater and Sewer Departmerrt shald�+e no�tified. �t shatl be un(awfiii#o
ar�y cons�ecting Iine un�7 an ins�ection has been made and such conpection and the wor€c inaderrt thereto has beere ap�roved tN the C"cty a
proper and sui�tabte connecFaora.
40Z.06 �iEPAlR��iltD�+[AJNTENAAiCE TQ CONAlECT10R1
A�ter the fnidaf connection fias been made�the water service curb stop box or the sewer�ad at the prope�ty iine vir a�ater senrice�ad
been exfiended#o ttse property iine for conr�ectian,fihe appiicarrt,owner,or occuparrt or user of such premises s(�aii be liable far�repairs
requires(�to arry water(ine and sewrer din+es aecessary for connectiarr of the premises frarrr the snain to fihe�remises. 1f the pnoperty otivner
requests maintenance sesvice ar repa�rs be perforrned by the C'ity,tfae�rope�rtty owner shatl be char�ed for#he�ts af the mairrtenance an
repairs,inctudirag necessary street repairs afi a r�ate set annuaity i�an adminis#ratixe po(icy. tt sfiall he the responsibii"it�r af tt�e a�licasrt,
owner,occu�arrC or user to perform s2andard mairrteriance of the sewer serasce line frflrr�tfse premises to the maia arictuding debris dearing
roofi�u�tCing end to mairrtain the water serui,ye cur(s sfiop box for operability and�t su�ch height as�rli ensure that it remair�s ai�ove the finisP
gratle of�khe�and or�Oroperty_ (tief 538,1156.1192a
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� City of Fridley
� Water Department
Address �� �C� C�'<c'�l"�'�'� l�'1
Name �i//l��G! � �d� �.. _
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Date �To1� ��'J G
� �ld Metez` Number �L �
�:�k
Old Meter Reading r� �D � �� � .
Replacement No. a-
� Replacement Reading d���d v`�
Replacement Make u . ��"
. , Remarks: �J ���� f�2�%�✓'�
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Signed '
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� CYCLE 2 ROU7E 9
LMR METER NUMBER ACCT NUMBER 1431
2132 84619112 30175-473230 15760 � `
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�WATER TE READING �
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�' 1�t 4 2 9 U DATE READ J ��
ENTE BERS INCLUDING ZEROES
FR�OM: KENNETH I.UKE i��'�' "�`�'
1341 CREEK PARK LN NE
FRIDLEY MN 55432 � \ ,v/_ �,
a-i so
SERVICE ADDRESS: 1341 CREEK PARK LN NE ���
RESPOND BY: 7/10/06 0018'