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• Request Number: 14737
Public works Division
Service Request
Problem Address: 1385 Skywvod Ln Requested By: Clark �
Department: WATER Address: No address provided
Problem/Issue: 'IURN WATER ON/OFF Phom Number:
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Sc�ed e e: 2017-04-19 � Scbe�td'i'Ime: 09:00:00
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Created by: Wendy Hiatt Dste Cre�ed: 2017-04-17
ACTION TAKEN:
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Stakus: In Progress 5nbmitter Has Beee �
Contacted
Date Completed: Completed by:
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�����.Y4IA'!'�t�,S�"Oif�W�A�7'�4$�IN�SAtNt'i'ARY SEWER
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�rior to cons�ructirr�or e^e�aair of any war�er tsfr seuver i�ziae cbnnec#ing the e�rasiang rnunicipai sys�Eem and arry�ouse crr fna�idi�fnr arhich tf
applscation is anacte,ttae owner or corrtract�r shalt be reyuired to obtair�a pernsi�fo�-suda oonne�tiori,and sJaali pay a�termr2 fee as provi
Cha}rter 1�of thas�Cade_ After such cr�nnection has beer�rnade,the�U'ater and Se+ver D�a►-fr�aeraC sha!!be�aatified Ft shali be unlawfvl t
ar�g�onnecting iine un�il an inspection has been anade and such cvnnectiors anci the wor�inciderrt thereto has been aPProved by the Ccty
pmper and suitabde r.annectiora_
�ilZ.�6 #iEPA,�R��1tM��itA(i4tTENAPdCE SQ�O1F�fECi1{?DN
�fter the snr'b"at sonrtection has been made�o the ura�er senrice a,rb sto�Iao�c or�he sewes�ad at i�se propert�lirre vr a rrater�nrice lea�
been extecasled to fihe prvperty line for conraectian,the app�i+ca►rt,ovr»er,�r rscczaparrt a�aser v�srsch premises sfiai!be 1'ja�e forall re�air.
requirect to assy water l�ne and sewer iines s�ecessary#or aonnecti4n aF ttae;premises fram the snain to the premis�s. lf the pr+nper�y oame;
reques�mairrtenance service ar rega+rs�e perFormed by the f"'.rry,the prop�r�y cmvner shatl6e charged for��uf�he mairrtenance a
repairs,ir�dudirag ne�essary street s-epa'rrs afi a+�ate seC annaaliy bX an administra#ive pol�c�. �t shaf!f�e t�e respor�ss'hit"r�y of the ap�ica�
o�,vner,occuparrt car user to perform s�andard a�nairrteri�nce aF Che seurer seraice�'ne frnm ihe prert�to tfte main artduc�ng debris d�arir
rocrE�atCing arad to mairrtain�se u+ater service curb stap box for ogerai�ility ansd at such i�eight as�adll ens�.rre l�at it r�emains a6ove the fini:
gra�de of the land or oropertY- �i�ef 638,2356,1192�
City of Fridley
�ater Deparbnent
, 6431 University Avenue i�E
. Fridley MN 55432
� (7b3) 572-3561
Uwe hereby authorize the City of F�idley ancUor its
empIoyees to do w3�at is necessary tQ shut offthe water at the curb stop box. I un.dersta�d
tha.t the progerty owner zs liable for the water line from the main ta the premise. (Per
Citp cade 402.Ob) I also hold the City of Fridley and/vr its emplayees harml.ess for�y
dam.ages that may occur while doin,g thi.s ogeration, T�v.s to include,but not lim'rted ta,
svd,yard,landscaping,trees,�hnibs,driveways,sidewalks or the curb stop box and
service line. i understand I am alsa r�quired ta obtain a pemii.t prior to atry wor�
Name; Address:
Phone Number: Da�e:
Signafi3re:
'G�Iilness Signat�zre: .
� �'RI�}LLY C.TTY CODE
CIIAPTER 402.'WATER,STURM WATER AND SAN�rARY SLWL+R
ADIVIINIS'TRATIOI�T
(R.ef QrdNo 113,464,565,566,629,638,6S1,922,9&8, 1144,1156,1191}
4Q2.U5. PF1tMiT FTE
Frior ta consttuctm�or repa�¢of any water az sewez line cannecting tize existiag municipal sy�fiem and�y
house or building far which the application is niade,the owner or aontractor shall ba reqaasd to obtam a
pesmi.t for suc�s co�.ectirnu,an.d s�Uall pay a.permit fee as pxovided in Chapter 11 af this Code. After sach
caffisciion has been.made,the Water�.d Sewer Depaztm�nt sY►alt be notified. It sliall be maia-wf�i to�over
any conn.ecting line uni�an inspecti.on has heen made and such conue�tion mid th.e w�rk imciden#thereto
has been apgroved by the Citp as a proper an�sirif.able cann.ection.
402.06. REPAII2S A1V1}MA.A.V'I'�TANCE T4l CONNECTTOI�T
After the initiai connection has been made to the water service carb stap box or the sewer lead at the
ProP�nY liae or a water servi.ce o�s�wer leaci has bee�o.extended to the progerry line for t�ane�lion,l3�e
applic�t,owner,or the occu�a�st or user of such premises shaIl be Iiable fox aIl repairs rec�m.'ed to auy
water line aud anp se-c�er lines necessary for canneciaon of the premises from the mam�bo ttie pzemises. If
the property owner requests maintenan.ce services ar repairs he perfoimed by the City,the prap�rty awngr
shalt be charged for the casts of the�a.i�tenance�nd/or repairs,including any necessary sfreet repa�irs,at a
rate s+et a�mually by an.a m���:ive poiicy. It shall be#he respans�bY`liiy of t�5.e applicazt�Qwner,occupant
or user to`perform standard�_��+ce of the sewer service line�the gre�ises tn ti�e mam.mcluding
debris elearing�r roat cudang aad to maintain.the water servi.ce c�b stop box far agerab�ity and at sncb.
hei.ght as will ensgre i�at it remains above the faris�ed gcade ofthe land or praperiy. (Ref 638,1155,1191j