Meter Swap C��"�s����-se��e4�
.�=��'' $������������� 3�13-�a 31�D- �/
, � �����������4��.�������
������� ��s s��.3� sa�/ �z��
a��-.s��-����
���;ve herebe�aeatharize the�it+,�o��Id4ey and�'nr its 2erep9a�ees to dv�ar6sat�s�aecessary
a��siaca�he,erat�r soaet2r. �ae�d�rstanci t9aag t9�e�e�perfiy ow�er as�iaisle for xlae water iine frvrn�he maiea ta the ar�mise and a1t�e3teenior
�Sduea�ising, ��er�'�cosle 4��.dB6� 9 atsca laold tiae�:flf�ridley as�dJits empioyees fiarmtess#or ar�y darrwges�fiat rnay orcur w4aite doing C
��ee�aone �es t�inc9wde,�a���aat lim+ted�valves,piPir����ra{[s,�aors�r�Ese custa sta�s box and sereice iine, dn undersCand�am also rec
t�o�tairt a�err�aifi;�r�or�o aray w�orfc,�ner�ssary.
��NA��ltE� itEe�D61�tG old rr�+e#e � ��
� ��
�am���L:f� �� L%�
���__ ��o •- �5 �E
i�t�one�ium r � `Y..<��✓ v f�" ^ V'!1� J'+�
Stgnatur — �� �Ala?tness Signature
� a.;`
o�� ���� - y��
�L� �EAl�9N�_ �"��t�/'�i►� ���
NE1�/lV9�'�#�#_ �� J �C�L��
�i1���1�l1��_ � -
��#_ 6 � �i.� �-�� ��
F�i[DL�'l�@�''f�QDE
��#I>����.�iNx1�'�8�, S'�S�fl4V�Y4��'�E9$�►YD SI#�(9�'AIZ'Y SE41fE�t
�O,�iVSt4�1115�'�,A�'f04� �'�
�
���f�+�1�!o�.13a�,�65,56�,52�,53�,�bC�,9�,988, 1144,1356,119�}
402.5 9�El21Mi3'FEE
� Prior�o constructing or repair�arsy water of seyver line connecting tl�e existing munici�a[system and arry house or�uitding�os wh;c.�t the
a�apticatiQn is rnade,the owner or corrtractor shall be required to abtain a permit for siacd�sonRection,and shail�oay a permi#�ee as provided
�hapt�r 21 of thls�nde. AftQe-such coanection has�een made,the Water and�ewQr Departmerrt shaii be notified, !t shafl be a�niawfut to cc
any co�anecting�ine unti(an ins}aectior�has been made and such corereection and�tee�r4r�C incident i�ser2to itas been approved by fihe Gity as�
�acoper and suitable sonnection.
�02.06 1tEP�iRS As�(D MAiN'�'ENANC���ORINEC'97Qlu
After�he 3nitial connecfiion has been made to the avatar senrice aarb stop 6ox or the sewer tead at tfie�ropeRy line or a arater service(ead t�:
been ex:ended to fihe property iine for connection,the appli�car�t,oarrter,or occuperrt�r suer aF such premis�s shail ite liabte for ati repairs
requirec!fio any water line and seaver 4ines necessary for connection of t�he,�remises frvm the main ta the premise�, tf the property owner
requests mairnenance service or repairs be pecfvrmed by the C"�ty,the property owrte�sha(t be charged for t�he costs af the mairrtenartce andi
re�air�s,including necessa�street repairs at a rate set annuaity by an administrative policy. ix sha(t be t(ie respoosibility of the applicarrt,
owner,occu�sara�qr user to�erform standard snairrt�nance of tl�e sewer sen�ice line from the�remises ta Che main includin�debris clearirtg fl
r�xo#�u�ting and to rnaintain the+avater service curb stop box fflr o�erahiliity and at wch height as wili ensure tttat+t remains al�ove the#inishe
grade 4f the(and or property. (R2f 638,3355,1191)
r .
r
j
REQUEST FOR SERVICE REPORT
CITY OF FRIDLEY
Reference Na Date: $— � �j-��
Request Type: Entered By:
Department: Citizen Name: �3�.?
C�R�T
Address: i����'� Phone Number:
�?63-�8�1-�l3$v�
Scheduled Date: Property Owner:
�
` Location Details: Request Details;
Action Taken:
l t��`-�'�°�-�.- (�
��
Responsible Person:
ApProver:
Completion Date: `� �,_�� Citizen Notified:
�