Meter Swap � f�
Request Number: 14151
Public works Division
Service Request
Problem Addreas: 5240 Lincoln St Requested By: Euge�Peterson
Department: WATER A�reas: , No address pro�ded
Problem/Issue: INSTALL AMR METER Phone Number: 5'11-1923
Sche e: 20 7-03-29 �,,,,� Se�ednled 17me: 10:00:00
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AC7ION NEEDED:
Created by: Wendy Hiatt Date Created: 201�-03-16
ACIION TAI�N:
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St�us: in Progress �lrmitter Has Been r.
Covtacted
Date Completed: Com�eted by:
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N AY�.d—�.YB L�ai�19�11�
t,f�er� laere6y au�tho�ize tfae�5��f�r�ley arad��e-its emPdogses ta a��anv�rat ds ne�ce
r�ego9ace�e�ra�er�rae�ec. ��as�derstand t�sa��€ae�r�pe�can�nes is dia�ale fass�he wvater 6ie���rom the snais�fio�ae premise and all is�ter
�Staarradsiaag. {8�e�-�City cos9e�2.06� �als��t�ir1#fie�'stt�rs��dle�,�and/a�t�s�m�lrs,yees d�aemless for any�lamage��[�eat saaay�cc:.;s�4aite�c
� ,!` ax�es�or�_ �'iass�a�ncts�cE�p 4a�zt�cr�8eaas5teci 3o valves,�alping watfs,fdanve�s�r 3�ee ea.trta s�t�,�&�ox and seavece�ine. In�xasdee�stanrt�am aL
tr�o�fiaiea a pea�crait�ar�ar�o a •s
ery�v�a-�,if�tecessaraj.
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cEl�4�2.1�A1'�R,S�'O�WA�,7'�4�At1iD�ANRARY SEINER
AD�AH1liST�A7T�?fIP
(��C�r��'d��.13,asAE➢�65,S�s,�529,638,�2,9z2,�ss,u�a,sa5�,�1s1$
4UZ.S PER4tit4T FE£
Pr�or to cvnstraacting or�epair oF any water vFse�rer iirae connecting the ex�sta�vg rnunici�eal system and arry fwuse or buldfr�fa:which t�
8�7}7I3'C�lflli IS l31c"�t�2,the oav�er ve coartractnr sfiaid be requieed i�ohtain a permct for sucfa w�mectiora,arnl staall pay a�esmit fee as provi
Cha�ter��of this Cade. After suct�corrnectio�has beea nsade,the�Ilater anti Se�ver Departrr+errt�tali be aotified. tt�zatl be unfawfui t
aray r.ona�ectang line urr�7 an ir�,spection has i�een znade and�ucf�connection and the wa�c[naderrtthereto has bee�e aPPr'oved by the Cfiy
proper and st�i�i;ab{e conneclio�a.
�02A6 �tEP1�tR�AhitB�A1RtTEAfA3eiCE TO COMotECt'l04Vt
;4�er the iniLial sonnectivn has been made�o the�rrater service curb stop boer ar�CFse sewer leat(attfre Properqf��ne or a�rater se+vice�ea�
beer�eicfiesaded to�the property line for connectiorr,the appiic�rrt,ovmer,or accu�arrt ar axser af such premises shati be i'�tale for a11 repair.
reqaires!tv arry�rater line and sewer�rtes aecessary#or connection of the prem'rses from�e main tn fihe premises. tf the propertrj orvnei
�eqcaest�mair�tenance service or ne�rairs 6e perFormed 6y the C'it�f,�ae�roperty aws3er shail be cbarged fior the�s s�Yhe mairrCenance�
rspairs,includirag ne+cessary;treet repairs at a rate set annualF�+1r�an asJmin�stratfire pol�cy. tt shaq be the responsr?ail"rty of i�e appiic�rr�,
own�r,accu�arrt+�s user to perform standard mairrterrance of ifie seurer seraece line frorrr ghe prem�es to the main�ncludirrg debris dearir
roat�z,t�ing a�d�o ma�rrCain the wa�ter senrice a+rb sto�6ax#or operabiiity and at su��aeight as will ensure Chat it remains abobe the fini
grade of the�and or�tro�erty. (t{ef 638,1156,1192)
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Ci�ty of Fridley
U' Wat�r Department
Address � ��� /��ief'a �� ��
Name `Zl/�. ��" �r�SU�1
Date � "/ � .
Old Meter Number L � o �$ G 6
Old Meter Reading �Z`41 Z Q
Replacement No.�y l 3 � � 'y
Replacement Reading d
Replacement Make //��`���_
Remarks: dl� G7/' Y �'''�^�� �fi',�'r�l'-
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