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C�A�ts
Dep�u�nent: Vi�ATER Adit�sss:
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Pto�i��/�e�s: INSTALI,AMR METER Pf�one Nun�ber: 612-666-3252
�eirsd�l D�te: �•,'cla�d Tl�ne: � ��
AC"'1�UN NE�DBS:
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- City of Fridiey S� � � � � �
Water Department ����,
6431 University Avenue NE �����'�0 �
, Fridley,MN 55432
763-572-3566
i/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
repiace the water meter. I understand that the property owner is liabie for the water line from the main to the premise and all iMerior
plumbing. (Per City code 402.06) I aiw hoid the City of Fridley andrts employees harmless for any damages that may occur while doing this
operation. This to include,but not limited to vaives,piping,walis,floors or the curb stop box and service line. In understand I am also required
to obtain a permit prior to any work,if necessary.
FINAI METER READIN6(old meter)
Name: Address 1Py.�� ��� S� j/,���� Gr��,� '"/"��
Phone Number Date � �� �
Signature Witness Signature
OLD METER# �7�y ��1 � SIZE & STYLE(Circlel
OLD READING 3 s� ) 7 yD� 5/8" HEX
NEWMETER# y�y� ya59 1" HEX
NEW READING � 1�4" ELIPTICAL or HEX
ERT#�7 3� �� 2» ELIPTICAL oriY I�EX
FRIDLEY C{'{'Y CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and ar�y house or building for which the
application is made,the owner or coMractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connection 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.
402.06 REPAIRS AND MAINTENANCE TO CONNECTION
After the initiai connection has been made to the water service curb stop box or the sewer lead at the property line or a water serv(ce lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premises shall be liable for all 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 shail be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shall be the responsibility of the applicarrt,
� owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main including debris clearing or
root cutting and to maintain 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)