Meter Swap � Q��� INSTALLATIO /�
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�.�,� AUTOMATIC METER READER
Fwa�r
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Name ��� ���L��
Date C� 'l�7'� � v'�
Old Meter Number �
Old Meter Reading —1�
Replacement No. - �S�
Replacement Reading (�
Replacement Make ��C��
ERT# ��� 1 � L5� ✓
Replacement ERT#
Remarks:
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� . City of Fridley
Water Department
6431 University Avenue NE
Fridiey, MN 55432
�763j 572-3566
1/we hereby authorize the City of Fridley and/ar its
empinyees to do what is necessary to replace the water meter. I understand that the property owner
is liable for the water li�te fram the main to the premise and all interior plumbing. (Per City code
40Z.06) t a(so.hold the City of�ridley artd/its employees harmless for any damages that may occur
while doing this operation. This ta include,but not iimited tv;valves,piping,walis,floors or the curb
� stop bnx and service line. I understand I am also required ta obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � ��-�'���
� �'�;LI�� ��u�
Name: Address:
Phone Number: aate: �� J�1�
� Signature: �� ����
. Witness Signature: 1/ Y.. ��-� ,
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATIQN
(Ref Ord Na 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anrj house
or building for which the application is made,the owner or contractor shall be required ta obtain a permit for such
seT�����Ten,an�shali�aT���rmit fPP a�nrovided in Chapter il of this Code. After such connection has been
made,the Water and Sewer Departrnent shall be notified. It shall be unlawful ta cover any conne irrg�tn "
inspection has 6een made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
4a2.06. REPAIRS AND MAlNTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop bax or the sewer lead at the praperty
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 liabte for all repairs required to any v+rater 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 shall be charged for the costs of the
maintenance and/or repairs, including any necessary st�eet repairs,at a raCe set annually by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant ar 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 wilt ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191j