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�enaiCe �iet��sested replace metez �a#e 4/21/09 Tcme 1:50 PM - �.
[?e�art�esat Public Aorks �idision Water
Location o�Se�ic� �eed 890 Mississ�ppi St NE ~
flwner or,�gerat of F'roperty La�Y php�e: �}�) 715-497-3045
�ame of Gitizen i�taone: (I�)
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�ddress
Detaiis of r3equest _ Please replace old, leaking meter. The house is vacaut � there is .
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�.�� AUTOMATIC METER READER
FRIDLEY
Address � 1�� (V 4�5� : � l
Name �/ArtZ�1� �['�2��
Date �—�-� ��
Old Meter Number � �� d�
Old Meter Reading ��4� t�
Replacement No: _ �M.�"��`SQ�� `�"�C
Replacement Reading �
Replacement Make L�
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Replacement ERT#
Remarks:
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- City of Fridtey
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
��wQ hereby authorize the City of Fridley and/or its
employees to do what is necessary to replace the water meter. 1 understand that the property owner
is liabie for the water line fram the main to the premise and all interior plumhing. (Per City code
402.06) l also hotd the City of Fridley and/its employees harmtess for any damages that may occur
while doing this operation. This to include,but nat limited to;valves,piping,walls,floors or the curb
stap box and service tine. 1 understand I am also required to obtain a permit priar to any work,if
necessary.
finai meter reading(old meter) �\ J� � '�
Name•
Address: �� �t�� �
Phone IVumber• pate' �' L —1�
Signatu�e:
�'�- '�,. G��
. Witness Signature: .
FRIDLEY C{TY CODE
CHAPTER 402.WATER,STORM WATER,ANd SANITARY SEWER
� ADM{NISTRATlON "
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156, 1191)
402A5. PERMIT FEE
Prior to constructing or repair of any water or sewer fine connecting the existing municipal system and any house
or bui{ding for which the applicat"son is made,the owner or contractor shal!be required t4 obtain a permit for such
connection,and shaA pay a permit fee as pcovided in Chapte�11 of this Code. After such.connection has been
made�the Water and Sevuer Department shali be notified. lt shall be unlawful to cover any connecting line until an
inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06. REPAIRS ANd MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer lead at the property
line or a water servi�e or sewer tead has been extended to the property tine for connection,the applieant,awner,
or the occupant ar user of such premises shall be liable for all i�epairs required to any water line and sewer lines
necessary for connection ef the premises from the main to the premises. lf the property owner requests
maintenance service or repairs be performed by the City,the property owner shalf be charged for the costs of the
maintenance andjor repairs, including any necessary street repairs,at a rate set annually by�n administrative
poticy. It shal{be the responsibility of the applicant,owner,occupant or user to perForm standard maintenance of
the sewer service line from the premises ta the main including debris clearing or root cutting and to maintain the
water se�vice cu�h stop bax for operabifity and at such height as will ensure that it remains above the finished
grade of the land or prope�ty. lRef 638,1156,1191j
Request Number: 12109
Public works Division
Service Request
Problem Address: 890 Mississippi St Requested By: Sandi H
Department: WATER Address: No adc}ress provided
Problem/Issue: FINAL ME1ER READING Phone Number:
Scheduled Date: Scl�ednled'Ilme:
ACITON NEEDED:Final reading.Closi 10l17l16 T#33371008
Created by: Wendy Hiatt Date Created: 2016-10-19
ACTION TAI�N:
.............................___._�������?-..__..._�.���.�..........................._._..�.._.....__-.--___......._.._._.._........_..._________. __._ ___.
Status: In Progress Submitter Has Been r
Contacted
Date Completed: Completed by:
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