Meter Swap Request Number: �
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S
pI1�IC wOYkS D1VISIOII
Service Request
Problem Address: 6979 Hickory Dr Requested By: Pam Burns
Departmeut: WATER Address: No a�lress}xovided
Problem/Issue: INSTALL AMR ME1ER Phone Number: 763-64?-8273
Sc6eduied D�te: 201?-OS-24 �dnled 1ime: 11:30:00
1
U
AG7ION NEEDED:
Created by: Wendy Hia�rttt Date Created: 2U 17-05-22
ACTTON TAKEN:
�In � ���
Status: In progreSs 5ubmitter Ha�Been r
Co�s�cted
Dxte Comptetedc Compteted by:
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City of Fridley � � �� r I�
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� Water Departrnent ���� �
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
!/we hereby authorize the City af Fridley and/or its empioyees to do what is neoessary to
reptace the water meter. 1 understand that the property owner is fiabfe for the water line from the main to the premise and all interior
plumbing. (Per City code�t02.06) I afso bold the C'rty of Fridley and/its employees harmless for any damages that may occur while doing this
operatio�. This to include,but not limited to valves.Qiping,walis,floors or the curb stop box and service line. In understand i am aiso required
to abtain a permit prior to any work,if necessary.
FINAL METER READIMG(old meter) ��� �`'"'��
Name:�QN� �YY�r Address �
Phone Number ` �� ��~ �(/��a� � Z�' �j 1
Signature_ Witssess Signature
OLD METER# � ` �� �v� 1
OLD READtNG � O� J��
NEW METER# —1 {ZZ�v� �
NEW READfNG �
ERT# ����� c..� I � t
FR(DLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,538,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of arty water of sewer line connecting the existing municipal system and eny house or bui{ding for which the
appiication is made,the owner or co�ractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter il of this Code. After such connection has been made,the Water and Sewer Departmerrt shall be notified, lt shail be un{awfui to cover
any connecting line until an inspection has been made and such connection a�d the wock inc+dent thereto has been approved by the City as a
proper and suitable connection.
d02.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initial con�ection has been made to the water service curb stop box or the sewer lead at the properry line or a water service lead has
been extended to the property line for connection,the applicant.owner,or occupant or user of sucfi premises shaN be liabie for ail repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property owner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the casts of the mairrtenance and/or
repairs,including necessary street repairs at a rate set annualty by an administrative policy. ft shali be the responsibility of the appliqnt,
owner,occupant or user to perform standard mair�tenance of the sewer service line from the premises to the main indudiag debris clearing or
root cutting and to mairrtain the water service curb stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)