Meter Swap uvase���ar�a�ent
5�i31 lDnHv�rsity,s���a��ae AfE � �l ��3 � �
Fradteyg M61F 55432
753-572-3566 � � 3_—� �� � �(�; _� �
; f � ,A'"�� hereby authorize#he�'rty of Fridley and/or its empioyees to do what is necessary ta
replace#!�►e wafier sneter. 1 understand that�he property oarner u{iabie for the+aater line f�om the main to the premise and all irnerior
pPumbing. (Per Crty code 402.06j i afso hold the City of F�idley and/its employees harsnless#or a�damages that may occur while doing this
operation. This to inciude,bufi not limited to valves,piping,watis,floors or the,curl�stop boz and senrice line. In understand!am also requir
to obtain a permit�rior to arn/7erorlc,if aecessary.
FINAL METER READIAIG(ok[meterj L �� �
Name: Address--["! VlJ w �t�'�i �
Phone Number f 2 ���' �p�j ! 2 p� �' �(', ��
Signatus�e Witness Signature
OLD METER# ��5� �O ( �
2 �. � �a��t� � �����
OLD READtiYG � �
NEW METER# �� /� ��p ` 3
NEW READfNG X�
ERT#_ / ��/ � /��
FRiDIEY CITY CODE
CHAPTER 402.WA7ER,S[ORM W,p►TER AND S,�W{TARY SEWER
ADMINISTRATION
(Ref Ord 61io 113,4�64,565,566,629,638,662,922,988,I144,1156,I191)
402.5 PERMIT FEE
Prior to co�structing ar repair of any water aF sewer line connecting the existing muniapaf sYstem and arry hause or buildir�for which the
appiication is made,the owner or cor�tractor sha(1 be required to obtain a permit for such connectton,and shall pay a permit fee�prcnrided in
Chapter 11 of ihis Code. After such cannection has been,made,the Water and Sewer Departrnerrt shall be notified. tt�all be uniawfui to cove
arry connecting line uMi!an irsspection has 6een made and such connection and the wo�c inciderrt thereto has been approved by the City as a
proper and suitabte connection.
402.06 REPAiRS AfYD MAINTENAMCE TO CONNECfiON
After the initiat connertion has been made to the water service curb stop box or the sewer lead at the property line or a water senrice lead has
been extended#o fihe groperty line for connedaon,the applicarrt,awner,or accuparrt or user aF such premises shail be Ikbie for all repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property orrner
requests mairrtenance senrice or repairs be performed by the C'rty,the property owner shali be charged for the cos#s of ihe mairrtenan�and/or
repairs,induding necessary street repairs at a rate set annuaify by an administrakive poficy. tt shaN be the responsibility of ifie appiicarrt,
owner,occuparrt or user to perform standard mairrtenance of the sewer service line from the premises io the main includir�g deb�is deartng or
root r.utting and to maisftain the water service curb stop box for operability and at such height as wili ensure that it remains above the finished
grade of the land or property. �Ref 638,1156,1191j
, . Request Number: 13155
Public works Division
Service Request
Problem Address: 1420 W Danube Rd Requested By: Becky
Department: WA1ER Addresa: No address provided
Problem/Issue: INSTALL AMR METER Phone Number: 612-414-6542
Schedaled 2017-02-10 Schedaied'Ilme: 10:00:00
. �� �
ACTION NEEDED:
Created by: Wendy Hiatt Date Cr��ed: 2017-01-30
ACf[ON TAI�N:
____._....__......_._......_. ...._..____._._.� ..____._...._._ ....._...._._...._......�__ �
..��;
Statuss In Progress Submitter HAs Been r
Coutacted
Dxte Completed: Completed by: