Meter Swap , � � --�,���� . � �
1�
��_ ..�
City of Fridley'
Water Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3566
�/We 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 liable for the water fine from the main to the premise and ali interior
plumbing. (Per City code 402.06) I aiso hold the City of Fridley and/its employees harmless for any damages that may occur while doing thts
operation. This to include,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand 1 am also required
to obtain a permit prior to any work,if necessary.
... _�.
FINAL METER READING(old meter] �� ��` \
Name• Address � J�./�'�� � : �� C��
^� , � _ . ._.._
Phone Number Date �"�'�� !
Signature Witness Signature ���'r�1ru�1
OLD METER#
�� � � � � ���L�`'7'��� k�
� �� �3�03 �`7��
OLD READING ,�� d��_
„ NEW METER# �� t i�JS ��T -'-7 3��-G �jll� �
NEW READING �
ERT# �C��� ,���� �'�,�
FRIDLEY CITY CODE �
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,119ii
�,;
w
402.5 PERMR FEE � ��
Prior to constructing or repair of any water of sewer line conneding the existing municipal system and any house or building fo�which the ,�
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provtded in
Chapter 11 of this Code. After such connedion has been made,the Water and Sewer Department shall be notified. It 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. `�
�
. . ..j�p . -,�6.
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 service lead haS�
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for ali repairs
required to any water line and sewer lines necessary for connection of the premises from the main to the premises. If the property w�rner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the maiMenance and/or
repairs,inc{ud'mg necessary street repairs at a rate set annualiy by an administrative polity. It shall be the responsibility of the applicar�t,
owner,occupant or user to perForm standard maintenance of the sewer service line from the premises to the main including debris clearing
root cutting and to maintain the water service curb stop box for operability and at such fieight as will ensure that it remains above the finish�
grade of the land or property. (Ref 638,1156,1191)
,,�
�
-.
c
� - REQUEST FOR SERVICE REPORT
��S C1TY OF FRIDLEY
Reference Na �� Dete:
. (D� —�-t�
�
�l
�
Request Type: f Y� Entered By:
�
Department: f Citizen Name: c�'t���� ^�"��L
vv �
MR�t�� �2
Address: �4� Phone Number:
�.�. ��a-�9- ����
Scheduled Date: Property Owner:
Location Detaiis: Request Details:
�r`� Action Taken:
C���,c,��, �� � �Z I�+e�
� JI�o�CZ��45`�� �1� ���� ��T��
�
Responsible Person:
�, Approver:.
Completion Date: ���ar� �� ��� Citizen Notified:
��.,--
. '-�,;.
�
=:��� � �
,_
�� � ., . ,�.,
Ftequ+e�t for Saervice Repc�rt
City of Fndle�
���,�r��: sot-rt7-�a� a��: �r1s�o�7
Request Tyrpe� install AMR n�eter Er��ned�y: We�dy��t
C�p�art�t: Water Crtiae.r��dame: i�cnthst�I�
Acidr�ss� �fi151 E�t F�iver Fioad NE Ca�ael€Fhc�n�e:
Sd� [7tate= Pr�perty doroner:
Lo�ion C�ails: R�q�iest [�tails_ �rstall ArNR
Actican Tak�n:
Qld r�er#�a�6d167 __�.�._� �_.__._._._._________ _ _. v
t�ci rea�ing: t�1�0
New met�#S�rne
flld ERT##�58�142
h�v ERT# �c
E �
i
; �i
�
I
�
i
�
�
�
� �
�
�
�
i
i
3
i
; �
�
' _._..._ _ ._ .. _ ____..�
Pep Peman _—_ —�_ _ __ _ .__
ftesp�ns�e P�rs�an: ;
i{cxy Jorg�s�,
+�p�v�:
n�arte: 9I1&/2'011 1�:45�M �� � �iz�t�ot�wed