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� INSTALLATION
unroF AUTOMATIC METER READER
FRIDLEY ,
Address 1C��l,l��— ��5�
Name � _)_� � Y ��
Date " �1' (�
Old Meter Number �� `� �
Old Meter Reading � �{�
Replacement No.
Replacement Read'+ng �
Replacement Make ���`� _
ERT# �,�. �3 b� �
Replacement ERT#
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City of Fridley
Water Department
b431 University Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City af Fridiey and/or its
empioyees to do what is necessary to replace the water meter. 1 understand that the property owner
is liabfe for the water line from the main to the premise and ali interior plumbing. (Per City code
402.06) 1 a{so hold the City of Fridley and/its ernpioyees harmless for any darinages that may occur
while doing this operation. This ta inciude,but nat limited to;valves,piping,walis,floors or the cucb
� stop box and service line. 1 understand i am also required to obtain a permit prior to any work,if
necessary.
Final meter�eading(old meter) �� �� ���
Name• Address� �[✓��O ��� �T
Phone Number: Date: �~ , `� ,
Signature:_ _fltX./� ��A"� S+-cs'�P�C.� ---
. Witness Signature:
FRIDLEY CITY CfJDE
CHAPTER 402.WATER,5TORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1156,1191)
4U2.05. PERMfT FEE .
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and any house
or buiiding for which the application is made,the owner or contractor shail be cequired to obtain a permit for such
connection,and shail pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shali be notified. it shali be unlawfut 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 CONNECTtON
Afte�the initial co�nection has been made to the water service curb stop box or the sewer lead at the property
line or a water service or sewer lead has been extended to the property line for connection,the applicant,owner,
or the 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
maintenaRce service or repairs be performed by the City,the property owner shall be charged for the costs of the
maintenance and/ar repairs, including any necessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility af the applicant,owner,occupant or user to perform standard maintenance af
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 wil4 ensure that it remains above the finished
grade of the land or property. �Ref 638,1156, 1191)