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- Request Number: 15016
Public Works Division
Service Requtest
Problem Address: 1619 Woodside Ct Requested By: Heidi Ft�auek
Dep�rrtment: WA'IER Addreas: No address provided
ProblemllsBue: INSTALLAMRMEIER PhoneNumber: 763-S�i-8608
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Schednled Date: 2017-OS-02 � Schedaled Ttme: U2:OU:OfI
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ACIION NEEDED:
Crexted by: Beth Kondrick Date Crc�ed: 201'7-04-27
ACTiON TAI�N: �
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5tAtua: 1n Progress Submitter Has Beea �.,
Cont�ted �
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D�te Completed: 5�� „ f� Completed by: ��`. �,,,
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�rior to constructing or�epair�f any mrater of sewer t'iraQ conneding t�se e�cistirsg munici�►aJ system and aray�ts�use br i�uilding for whic�t tf
appticatiara is sxsacie,ttae osvner or co�stracto�shatl be requPred to otrtairs a��rsa�sfi�cu sucEa aonneciion,and�eal1�aay a perm�fee as proai
Cha�ter 3�of this Code. After such connectios��Sas been made,#te�6fater and Server Departme�rt sha11 i,te natrF"ted. �t.�tail be untawful#
a+�}/�onr�ectiaig dine un�7 an irts�ection has 6een anade ancf such connectio�and the wor�inaderrt thereto has�eera aPgmved by the�ty
proper and suitabte consaedaora.
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After ffie inr�iai conneclaon has been rnade tn the wafier service curb sto�bo�c or ti�e sewe�lead at fiF�e propecty�is'�e�a water�roice�
faeen ex�ecar�ed to the prvgerty(ine for conraectian,�(ie appiicarrt,oarrner,sss�t+�cupari#or aaset aF such premises.�a[!be tiaMe forall��air.
require�to arry water line ar�d sewer[i�res nQcessary for�on»ecCivn aF the p�emises i'mrn the main to the Qremises. !f#te pmperty ownei
requests+�narrstenance sesvice or re�airs f�e performed 6y�Fte C'rtY,tPae propsr�yy aarner sfiail he charged for the�os#s o#�e maisitenar►ce a
repairs,ir�ctudisag necessary,-ttreet repairs afi a rafie se�t annually bX an adra�ix��re po!"�cy. tt shaif i�e t�e resporrsi�rTi#y offiE�e ap�icant,
s3wner,occu�arrt�ar user to perform stansiard a�nairrCerrance of i�e setiver seraice lir�e fra+�ts i3�premises to fihe rnain anduding c��is dsarir
root cc�tfiing arad�o rnaisrCain ti�e water servi+c�curh stop box fa�operafaifity and�sur��ieigfrt as w►ii!ensure tfiat it remains a�iove it�e fin�:
grade af ths#and or�aroperty_ (i�ef 638,1aS6,1192j
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Addrerss� / �l3G�S,c�. �' :...
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Name ' ���e �1^a�g,�
Date_ �! �� 4 (y
, Old Meter Number ��
Old Meter Reading �33 ��
P " 3 �� ��� 2-�
, Re lacement No._ �
Replacement Reading d
Replacement Make ,����r.,�
R�marks: ,�To �,,,,Q �r
Signed �