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G.��. AUTOMATIC METER READER
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Name f���� �E'D� �C��
Date ����)" � s�-
Old Meter Number �� �
Old Meter Reading
Repiacement No. ���w�� ��
Replacement Reading
Repiacement Make
ERT# c c7�� ����
Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
i/we hereby authorixe the City of Fridley and/or its
employees to do what is necessary to replace the water meter. I understand that the property owner
is liable for the water line fram the main to the premise and all interior plumbing. (Per City code
402.06) i also hold the City of Fridley and/its employees harmless for any damages that may occur
while daing this operation. This to include,hut not limited to;valves,piping,walls,floars or the curb
� stop box and service line. I understand i am also required to obtain a permit prior tu any work,if
necessary.
Final meter reading(old meter) �� �� ��
Name: Address: �L>�� �� �"`'"�" �" � �,
Phone Number: Date: � ��` l�
Signature:
. Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,488,1144r 1156, 1191)
402.05.RERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and any house
or building for which the application is made,the owner or contractor shall be required ta obtain a permit for such
connection,and shall pay a permit fee as provided in Chapte�il of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shall be unlawful 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. REPAtRS AND MAtNTENANCE 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 tonnection,the applicant,owner,
or the occupant or user of such premises shafl be liable for all�epairs required to any water line and sewer lines
necessary for connection of the prernises from the main to the premises. If the property owner requests
maintenance service or repairs be pertormed by the City,the property owner shall be charged for the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annualty by an administrative
po(icy. It shall be the responsibility of the applicant,owner,occupant or user to perform standard maintenance of
the sewe�service line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box for aperability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)