Meter Swap 8/11/17 .��� - " �;�,����a'�� �'o�- �D4(���_ r��-.
rn�ate��e�ar�r�e�,t S�� ��?O
�431 llnaversity Avencae 6VE
FrBc6t�y,MAf 55432
763-572-3565
i�''"« hereby authorize the City of Fridtey and/ar its employees to do whafi is necessary to
replace the water meter. !understand that the property flwner is biabfe for the water line from the main to the premtse and all irtC�erior
plumbing. �Per�ity code 402.a6J I a{so hofd the�ity of Fridley andrts employees harmless for arry damages that+nay occur while doing this
operatiom. This to inciude,but not limited to valves,pi�ing,wa0s,#(oo�s or the curb stop lsox and service line. In understand i am also require
�o abtain a perrnit proor to any wortc,if necessary.
F9NAL METER REAQ1PiG{old meterj � ` �V
Name: Address ���5 ,��L�r�?�
Phane lYumber p� �j�--�, �"" ��'
Signatur Witness S+gnature
OLD d41ETER# �� t0�O �- ��
OLD READING � � l ��V
NEW METER#_ L��� �S v�V
NE111/READING _ �
��r#_ � ��� � � c'�l�7O
FR�o�er c�rr cooE
CHA1�7'ER 402.WA7ER,STORM WATER AND SANfTAttY SEWER
ADMlNISTRATiON
(�tef Ord No 113,4(i4,565,566,629,538,662,922,988,1144,1156,1191j
402.5 PERMlT PEE
� Prior to aconstructing or repair of arry water af sewer line connecting the existing municipal system and any house ar buifding for which the
appiicafion is made,the owner or contractor shalt be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Cade. After sacfi connection has been made,the Water and Sewer Departme�t shalt be s►otified. St sfiall be unlawfui to cover
any connecting line unfiil an inspedion has been made anct such cannection and the work incident thereto has been approded by the Cifiy as a
proper and suitable connectioa.
402.06 REPAIRS AP(D MAINTENANCE TO CON4YECTtORt
. After the initiai connection has been rnade to the water service curb stop hox or the sewer tead at the property line or a water service fead has
been e�etended to the praperty line for connection,the applicartit,flwner,or occupant ar user of such premises shall lae iiable for alt repairs
required to any water tine and sewer lines necessary for connection of the premises from the main to the premises. (�the property owner
requests mairrtenance service or repairs be perFormed by the Crty,the property awner shail be charged for the costs of the mairitenance and/or
repairs,including necessary street repairs at a rate set annuatty!ry an administrative policy. Ft shalf be the responsibility of#he applicant,
owne�,occupant or user to perform standard mair�tenance of the sewer service line fram Che psernises to the main including debris clearing or
root cufiting and to maintain the avater service curh stop box for opera6iiity and at such height as wiil ensure that it remains above the ftnished
grade af the lartd or pcoperCy. (Ref 538,1195,1191j
. . �
,� �
REQUEST FOR SERVICE REPORT
CITY �F FRIDLEY
Reference Na Date: �^��-�'?
Request Type: Entered By:
Department: Citizen Name:
t
Address: �''f�"�� ���,���� Phone Number:
Scheduled Date: Property Owner•
Location Detaiis: Request Details:
Action Taken:
t����- ��
��S C:A-����-.� �dZ�.� ��NL
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�d � t�S`TA-� �1 � � c��U�—,
Responsible Person:
Approver:
Completion Date: ,( � � t � Citizen Notified:
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