Meter Swap 's - �( �I�S=`f7�� t�
� ���� INSTALLATION
��.�� AUTOMATIC METER READER
FRIDLEY
Address fL1�, � '� "` �,�
Name � �� �f�l�l:-1
Date �"��" �t�.
Old Meter Number � � �
Old Meter Reading ��
Replacement No. A���JS
Replacement Reading tiv
Replacement Make � �
ERT# �'J J� ���j�
Replacement ERT#
Remarks:
���� Signed.
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� ' City of Fridley
Water Department
fi431 University Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley and/or its
empioyees to do what is necessary to replace the water meter. 1 understand that tha property owner
is liable for the water line from the main to the premise and all interior plumbing. (Per City code
402.06) t also.hold the City of Frid[ey and/its empioyees harmless for any damages that may occur
while doing this operation. This to include,but nat limited to;valves,piping,walls,floors or the curb
� stap box and service line. I understand I am also required to obtain a permit priar to any work,if
necessary.
Final meter reading(old meter) ��� � ���
Address: I' r!2� I)O� i..� a �/'__
Name: .
Phone Number: Date: a—����2 �
� Signature: �� ''"`r"
. Witness Signature: �'Y0�/'� `"
FRIDLEY CtTY CODE
CHAPTER 402.WATER,STORM WATER,AND SANfTARY SEWER
ADIVIINISTRATION
(Ref Ord No 113,464,565,566,629,638, 662,922,988,1144,1156r 1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connectingthe existing municipal system and anq house ,
or building for which the application is made,the owner or contractor shail be required to obkain a permitfor such
ze,,,�e��Ten,afl�shafl�a�-;a-Permit fPP a�nrovided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shail be unlawful to cover any conne (ng�in "
inspection has 6een made and such connection and the work incident thereto has been approved by the City as a ,
proper and suitable connectian.
4U2.06. REPAIRS AND MAINTENANCE TO CONNECTION �y
After the initial connection has been made to the water service curb stop box or the sewer iead 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 shalt 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 ar repairs 6e performed by the City,the property owner sha(I 6e charged for the costs of the
maintenance a�d/or repairs, including any necessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility of the applicant,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 bax far operability and at such height as will ensure that it remains above the finished
grade of the land or property, tRef 638,1156,1191j
R�quesf for Service Repc�r#
City af ���i�f1��
Rcf�erenc�No: ��,� ��"� '}��'� f3ate: �—'b'-t�
Rcqu�st Type_ ��p�(�C � �'l� ���� Ehterod Ry.
Deparkment: � w� ' L'iti�en Name' �� e����
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Address: �� ��� Cauback Phone: �(,,;Z _ �-7�-� _ j y��
EJJ < <
Schsduu�ed d�e: Property O+�er:
Location Deta�s: Re�est DMa�s:
Action taken:
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Fsespor,siab Person�
Approver.
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Ca+r�letion D ate: 1 — I�� '� �
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