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REQUEST FOR SERVICE REPORT
CITY OF FRIDLEY
Reference No. Date: �l �" �
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Request Type: Entered By: ��
Department: � Citizen Name:��'t'�.�'�
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Address: � �/� � n� � Phone Number•
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Scheduled Date: �bv �� ��� Property Owner• .
Location Details: � Request Details:
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Action Taken: �
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Responsible Person:
Approver: �
Completion Date: Citizen Noti�ed:
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��'�r� �aer�fo�as�tharize the�ty af�ridiey andJr�r its�sr��olo�ees�o dce�v6�at is�aecessary
a�e�Tace t�ae�ret.zr met�r. q und�a-sLand t�ea�the�r�gse��owner 9s�ia8sle frar ti9e water iine frorn the�aaaiea to the pr�seeise and aHB arater'svr
�iura�skaing, {Per C'+ty r.sade A�Z.�D6� �a8s+x kao8d�ae�St�y uf�r�d6ey ancd�'Cs ernployees�aarmtess f�r arey daeaeages�hat�rr�ay 4cccar w4�ile cfois►g t
��er�tion. '�'tois tm�nclude,4ae�t raat limites!to valves,�e�ira�wralts,f�oars or�se curt�stag iaox arad ser+�ce tine. �n undea�staad�er�a(so�c
fim odatairs a nemait�tr�or�aray w�ortc,�f�►ecessary.
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� �rdom fi�sonstr�rs�ing or r�pair�F any�arater uF sewer line Qonnecting the existfng muni�pa(syst�m anet any house or��suilding�or which the
a��siication is rnade,t�e owner ar carrtr�ctor shali be required to obtain a per�rsit for;uch�o+se�ectiorr,and shail pay a permit fee as provided
�hapt�r 9.1 aF tiais�ode. Aftea-sucia connectdon has�eerr made,ttae 9Alater and Sebsrer�epartmerrt sf�ai!be nutified. ifi sha(!be uniawfut to cc
an�connecting line unt6[an ins�sction has beer�made and such cor�rvection and the�,vor�c irscide+rt t�ereto has 4�een approved by#he Crty as i
gro�er and suitab�e�ortraectioa.
�.02.06 �t�PA(t2S At1fD fitlA,iIV�NAMCE T4���iVIUEC77OlY
A�ter t�ee 9nitiat connection has been made to the wafier service cur�sto�o�ox or i�ae se�rer�ead at the property ltne or a urater serv►ce fead h:
been e�ended to the�Srope�ty line for connection,the applicarrk,owrter,or accupant�s a�ser aF such premises shafl be liable for ati repairs
r�Ru�red tQ aray water line and se�ver lines necessary for conraection of�se,�remises from the mawn to the premises. !f the property oyvner
r�quests mairrtenance serv�ice or repairs be perfarmed byr the�ty,the property owner shal!be charged for the costs of th!��airttenance andl
re�airs,incYuding necessary sCreet repafrs�t a rate set annuaity�y an administrative poiicy. 9t sha(t be the responsibility of t�e applicarst,
owner,occuparrt or user ta�erform standard mairrtenance af the sewes service line from the�remises tv The main indudin�;debris dearing a
root�utting and to maintain the�vafiec;erv�ce curb stop box f+�r operabiJ'rty and at wch he�gh�t as wiii ansur�e that it remains above the finishe
grade of�he iand or,property. (Ref 638,�156,119�)