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' Request Number: 14213
Public Works Division
Service Request
Problem Address: 1668 Mississippi St Requested By: Carrie
Deputment: WATER Address: No a�dc�ess pcovided
Problem/Issne: INSTALL AMR ME'IER Pbone Number: 61Z-619-8124
Scheduled Date: 2017-03-3Q � 5c6eduied Time: d1:30:00
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ACIION NEEDED:
Created by; Wendj+Hiatt Drte Created: 2017-03-20
ACIION TAI�N:
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Statua: In Progress Snbmitter Hne Been r
Cont�ted
Ds�te Completed: Completed by:
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9��rr� �aer�6�r autl�osize t�ae�CS�o#��e�le�asa��'�ats e�pdoyees#o d��nvfiat ss nece
�-e�4ace�he mra$er�rae�es_ ��s�c8srs�:aaaat!�sa��lae�vrogaea�oarner as tia�le fe�s tl�ae�ra�ter lie�e feom the anaiss��ae premise and all anter
� - �Staare�a(sieeg. (��r�C"�ty sasie�D�.Of� 3 ats��r�id the�"sty�f�s6s31e,,r and/Sfis�rr►�Ira�e�s iaae�rreiess#oc aray�iamages fi#�at naaq�cca€�rrhiie�Ic
, o�eeasid�. '�'�aes�o'sn�l�ecfe,,R�u�secr��aaa��ed�sralves>�a�Ping,�vatJsy�9oors os-�ae�ear$s sto�kaax arac3 seav6ce liaee. 6ra�e�sd�e�stand�arra ai:
fi�o8�aira a�eee�an'st garsos�o aeay�ernr�af rsecessara,_
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�rior to constr'uctir�g or repair af ar�y wartec vf sewer ii�ae connec�ssrg tfse e�ristir�g municipat systerrr and arry fiouse uc burTdir�g for which#t
eppi3catifln is�ade,fihe oe�vner or r.orrtractor sfsall Ese required to obfiaiss a permst for such connectior�,arnt staalt�aY a t����ee as provi
�ha�Cer 3.�of�h�s Code_ A�er such corsnection has�een made,�fte a6fater and Sewea��epa��hald��ao�fied. �t shait�e uniawfu!t
aray cvna�ecting�ine uaa�an i�ection has�een anade and�uch connec�aan and the se�os�inciderrt ther�to has beese approved by tpre�rty
proper and suitable connection.
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�er tf+e initial cvnrtection has been made fio�the water servace curiz stop iar�ec vr tf�e sewer tead at ifie propert�iine ar a tirater s�rvic9e�ea�
fiee�a eacfientted to the property line for conned:io�z,�e app�ir.arn,ovomer,s�r accuparrt or axser of such prem3ses slratl be i'�6Je for a!f regair.
res�uire�i�o arry ava�te,r lirre and sewer�ines a�ecessary for sannection of i�ae p�emises from the main to the prem�es. if ttre pco{aerh!ownes
e�equests mair�#enance senrice ac regairs be perFormed t�y�he City,�ae�roperfiy awn�r shatl he charged for the�s rnF t[�e maisrtenance a
repairs,indudirag r�ecessary sCreet repairs at a rate set annua�ty�ry an adnninisira�C•ixe pvticy. tt sbai�be ti�e sespor�s�7aitity1 vf the ap�'icarrt,
own�r,occu�va�rt or user to perfnrm standard anairrtenance aF fihe seaver�s�atce line from i�e prem�ses to the rnain�r�ciuding debris dearir;
raot�u�ttCin�ar�d�a anairrtain the water servire curf�sto�6cnc for�gerafiility ant�at such height as will ensure that it remains aboae the ffni:
grade of�he la�d or property. (Ref 638,1156,9.3,91j
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city of Fridley
water Department
Address ��,�j� M�jrj�55tPd �
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Name ��`i`�J��GA ��q��
Date �� `'�`�b .
Old Meter Number
/ 5 I�� � �o�r���`i
Old Meter Reading �( C p�
Replacement No._ �y (�j ��
Replacement Reading �i
Replacement Make __����'�
Remarks: bLT� /1�,�---t�_
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