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, City of Fridley �Q� , �� � /�
� Water Department � � ���
6431 University Avenue NE 5
Fridley,MN 55432 -
763-572-3566
�/We hereby authorize the City of Fridley and/or its employees to do what is necessary to
repiace the water meter. t understand that the property owner is liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) 1 also hold the City of Fridfey and/its empioyees harmless for any damages that maY oaur while doing this
operation. This to include,but not timited 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: �t�w1 ��,V�i�� Address �+'�W �lG�►"'f Y �'v ��
Phone Number ��`'" � V�� � Date � " �v ` �
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�ignature Witness Signature
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'�, . OLD METER# G l � ` �'�' � SIZE & STYLE Cirde
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OLD READING /8" EX
NEW METER# ���� � I � � 1" HEX
NEW READING � 1%" ELIPTICAL or HEX
ERT# �� 3 � 85�0 2" ELIPTICAL or HEX
FRlDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER .
� ADMINISTRA'f10N ��a
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
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402.5 PERMIT FEE
Prior to construding or repair of any water of sewer tine connecting the existPng municipal system and any house or building for which the
application is made,the owner or corrtractor shall be requi�ed to obtain a pe�mit for such connection,and shall pay a permit fee as provided ln ti
Chapter li of this Code. After such connectioe has been made,the Water and Sewer Department shali be notified. It shall be unlawful to cover
any coanecting 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 MAINTEPfANCE TO CONNECTION
After the initiat connection has been made to the water service curb stop box or the sewer lead at the property fine 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 Itable for all repairs
required to any water line and sewer lines necessary for connectPon 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 shaN be charged for the costs of the maintenance and/or
repairs,including necessary street repairs at a rate set annuaily by an administrative policy. It shall be the responsibility of the applipnt,
owner,occupant or user to perform standard maintenance of the sewer service line from the premises to the main inciuding debris clearing or
root cutting and to maintain the water service curb stop box for operability and at sucfi height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)