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Publt� W�rks 0ivision
Ssrvi�� Requ�st
Prebl�A�idress: 6483 St�St Req�ed By: Tom-Manager for Villags
Cnr,ea Apts
. WAT'ER Ad�rt�:
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Pr . INSTAL.L AMR I►�TEl� Phons Nwnbs�: 612-666-3232
�ch�d�i Dabe: Sch�dnle�T1me: U-��
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City of Fridley
Water Department
6431 University Avenue NE a��,.r y(p,�?���
Fridley,MN 55432
763-572-3566
1/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
repiace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all interior
piumbing. (Per City code 402.06) 1 also hold the City of Fridley and/its employees harmless for arry damages that may oaur while doing this
operation. This to incfude,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand I am also required
,k:�Ik! '(ibtain a permit prior to any work,if necessary.
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FINAL METER READING(old meter)
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Name• Address W� cS � l }n� �/. ����-- �'�"«•^ �d��
Phone Number Date ��' �J✓ ��
5ignature Witness Signature �—�.� ---.
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OLD METER# :���i' �t/ ,�C>� sizE & STYLE(Circlel
OLD READING �� � �� 7 ��G'' S/8" HEX
NEW METER# '1 7���l I�t.� 1" HEX
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NEW READING (� !�~I ELIPTICAL or HEX /
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ERT# /a� 7 �3 �� 2" EL{PT{CAt�or HEX
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.5 PERMIT FEE
Prior to constructing or repair of any water ofi sewer line�nneding Che existing munQcipal system and arry house or butlding far 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 provicled in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer Department shall be notified. It shall be u�lawful to cover
any connecting line until an inspedion has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.� REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water senrice curb stop box or the sewer lead at the property line or a water senria lead has
been extended to the property line for connection,the applicant,owner.or occupant or user of wch pren+ises shall be liable for al!repairs
required to any water line and sewer lines neceuary for connection of the premises from the main to the premises. ff the property owner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of tfie maimenance and/or
repairs,including necessary street repairs at a rate set annually by an administrative poliry. It shalt be the responsibility of the appiicant,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main inc{uding debris cfearing 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)