Meter Swap Request Number: 13194
Public Works Division
Service Request
Problem Address: 5505 W Danube Rd Requested By: Troy Lanz
Departmeut: WATER Address: No ad�ess pcovicied
Prol�em/Iaaae: INSTAI,L AMR ME1ER Phone Nnmber: 763-516-Z219
Schedaled Date: . 2017-02-03 SchedW ed Time: 09:00:00
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AC'IION NEEDED:
C���d by: Wendy Hiatt Date Cre�ed: 20l 7-Ol-31
ACTI N T ����
St��us: In Pro�ress Submitter Hnc Been �
Contacted
Date Completed: Completed
2- � - 1 � `C� �
Watea��e�artvtient -'�, "� `f '�
6431 lDniversityr Aveaaue 9JE � � � � t J
' Fridley,MN 55432 � a2 � 1 ) � '7 'a s��v� ,!
' 763-572-3566 J v�
1Jwe hereby authorize the City af�ridley and/or its empiopees to do avhat is necessary to
replace�the water meter. 1 understand that the property owner 9s diable for the water line from the main to the premise and all ir�terior
plumbing. (Per Cdy code 402.06j i also hofd the Ciiy af Fridley and/its employees harmless for any slamages that may occur while doing this
operation. 7his to inciude,but not timt#ed to valves,piping,watis,floors or the turb stop box and service line. In understand i am also require�
to obtain a permifi prior to any�vorlc,if necessary.
FNVAL METER R ��� ` ��
EADING(a!d meter)
Name: ` v� .��f V Address ��V �J � �W�7�/G. �\'�'T�
Phoae Number � � V� D� �� �' y�,
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Signature Witness S�nature
o�o n�Er�R# �J��� c.���o`
OLD READEi11G ��� iC/� ��
NEW METER#_� �(�
NfW READING �
ERT#� �� ���$� .
FRIDI EY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEINER
ADMINISTRATION
�Ref Ord NO 113,Q64,565,566,629,b3S,662,922,988,1144,1156,1191)
402.5 PERMtT FEE
Prior to constructing or repair of any water of sewer line connecting the exisfing muniapal system and arry house oc buiidir�for which the
application is made,the rnirner or coMaactor shali be required to obtain a permit for wch connecfion,and shall pay a permii fee as provided in•
Chapter 11 of this Code. Aftec such conr�ect'son has been made,tfie Water and Sewer Department shali be notified. it shall be untawful to cvve�
any connecCing line urrtil an inspection has been made ancl wch connection and tfie woric inciderrt thereto has been approved by the City as a
proper and suitabfe connection.
402.05 REPAiRS AND MAINTENANCE TO CONNECTION
After tfie in'rcial connectiort has been made to the waier service curb stop box or the sewer lead aC the property line or a water senrice lead has
been eutended to fihe property fine for connection,the appiiqrit,owner,or accupant or user of such premises shall be liabie for all repairs
required to any water line and sewer Itnes necessary for connection of the premises from the main to the premises. tf the properly owner
requests main#enance service or repairs be performed by the City,the property owner shaq be charged for The costs of the maiRtenar�ce and/or
repairs,inciuding necessary street repairs at a rate set annuaily by a�administrative policy. tt sha(i be tfie responsibi{ity oF the applicarrt,
owner,occupant or user to perform standard mairitenance of the sewer service Gne from the premises to the main including debris dearing or
root cutting and to mairrtain the water service curb stop box for opera6ility and at such heigFrt as will ensure that it remains ahave the tin(shed
grade vF the{and or property. (Ref 638,1156,1191)
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Address ,�"�f�� LV� �r►�
xame _ a I� L �,n
Date �� �'� � ��
O1d Meter Number
Old Meter Reading 6 � ��� ,
Replacement No. �a �3 � �/
Replacement Reading �
Replacement Make �t��lr �
Remarks:��a"Q� _ � c3 �c� i�a�-G�-ny
' Signed �
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