Meter Swap ✓ Request Number: 13749
Public Works Division
Service Request
Problem Address: 1400 Mississippi St Requested By: Tom
Department: WATER Addresa: No address provided
Problem/78sue: INSTALL AMR METER PLont Number: 763-572-8528
Schedul 2017-03 9 Sc6edeled Time: 08:00:00
F � � ��C.J
AGTION NEEDED:
Create��: Betli Kondrick Date CrcAted: 2017-03-01
AC110N TAI�N:
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Stntus: In Progress Submitter Hns Been r
Co�acted
Date Completed: �j — ��. �,, Completed by: ���� �
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` ���°� her�foy eu�fif�orize the�i�af�ridley and(or its easspioq�ees to slo wl�at as oecessao
re�9ace the vrater metec. ;uanclerstand�aat the pro�aeriy flwner�s dia�le�ot�l�oe�rater Bie►e�rom the rnain ta�ae premise and all iarterior
' �atsarra�siag. (P���'Fty sosle��DZ.06) d ads+o hnld tF�e�'eiy of F�idley and/ifis erre�loyees harmless for any slamages tfaafi a�aay�ccur w�ite sto'scag
o�era�7on. S4ais�0 4ncfur8e,bu�R�e�di�a�s�fieel to valves,ga9ping,wails,�7�or�s or�e caari�sta�x k�ox arec{servdce lia�e. fre�saderstand i am also a�
to o�taira a�eraa�i��arsos tc+asay�v�r�,�F�ecessarye ! /_���
2t 5 _ `"� �- bt
F94ttAL�uiETER i�EADIf�G(olct metesj_�� � � � �O � 2�1 �3
1�ame: ��•v� Rddress �'"(�U �'l�SSo�j v��i/f/ .t7�".
Plaone ifum�r ���" d !� " Vc��Dai� 3" 1 '— L"'7
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Signatvre Witne.ss Signa#ears �""'
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CEi�'3'EI�40�.V6�A�lR,S�'ORAI!IAIA1TEJli AND S,AN(iAR�SEWEIt �
ADMIAIIS3�i.AT60f1f
�F��f Ord�to 133,�&4,565,�66,523,�38,�i62,922,988,I�.Q�,115fi,1191;
4t72.� PERriPf9T FEE
Prior to consi�nuctir�g or repair of any water of sewer iine wnnecting tt�e ex;sting anunicipal system and a+ry hause or b+xitding for wt�ic�#he
appiication is made,the owner oc mnfiracCfl�sf�att Ese reyuired to obtain a permit for such connectiur�,and staali pay a permiifee as providec�
Cha�rCer 9.�af t�es Code. After such conr�ection has been made,the�later anct Sewer Departmern sha11 be notified. tt shalt be untawfut in rr'
ar�y connectirtg d➢ne urrtil an ins�ectioa has been arwde and such canaection and the uror6�inciderrt thereto t�as been approved by tfre�rty as
proper and suit�bte coanection.
4(J2.06 ItEPA1RS AtEtt2�tl�11M'ENA�4ICE TO C01wRi8C770N
A�ter the inrt3a!connection has�een made to#he waa��eer servPce curb stop 6osc or the sewer iead at the property iirre ar a water senrioe iead h
been ententted to ti�e property)ine for conneckion,the appficar►t,vumer,or Qcwparrt or user of such premfses sfial!be C�atNe far a!1 sepatrs
repuired to any wate�r line and sewer tines necessary for connection of the prem�ses from#F+e main to tl�e premises. 1f the properry owner
r�equests rriair�#enance senrice or repairs be perFormed by tf�e�tya the properiy owner shati be sharged for the�osts af the mair�tenance and,
repairs,inctudirag pe,��ary street repairs at a rdte set annually b�r an adminu-krative polic�. it s6ai!be fihe respo�s�it"riy of the appiicarr�
ouvner,occupant rsr user to perform sCandard mairrtenance oF the sewer service line from fihe premises to the main aactud�rig de(�ris dearing c
root cu�tCing and to ma�rreain the water servir.e r.urt�sCap bvx for operability and at such�eight as w7i ensure Chat it recnais�abov��he finisfie
grade of fihe land or groperty_ (Ref 638,1156,17.91)
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