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Name ��%'�l ��k�P�ti��.
Date �'— i U�� � ;7�.
Old Meter Number � U�
Old Meter Reading ��d
Replacement No. `�,� ���5 ��
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Replacement Reading t�
Replacement Make �����
ERT# ����� � � V
Replacement ERT#
Remarks:
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- City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3556
I/we hereby authorize the City of Fridley and/or its
empioyees to do what is necessary to replace the water meter. I understand that the property owner ,
is liabie for the water line from the main to the premise and all interior plumbing. (Per City code
402.06) i also hold the City of Fridiey and/its employees harmiess for any damages that may occur
while doing this operation. This to inciude,but not limited to;valves,piping,walls,floors or the curb
� stop bax and service line. I understand i am also required to obtain a permit prior to any work,if
necessary.
Finaf ineter reading(old meter)
Address� IF�! � � ��� --
Name• -
Phone Number• Date: � _�`,L �L
Signature:
. Witness Signature: .
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,QND SANfTARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipai system and any house
or building for which the application is made,the owner or contractor shall be required to obtain a permit for such
connectian,and shall pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department sha4t be notified. It shail be unlawful to cover any connecting line until an
inspection has heen 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 CONNECTION
After the initial connection 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 liabie for all repairs required to any water line and sew.er 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 tfie
maintenance and/or repairs, inciuding any necessary street repairs,at a rate set annually by an admir+istrative
poticy. ft shall be the responsibility of the applicant,owner,occupant or us.er 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 will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)