Meter Swap l��'-�f��r��v
�� �'�" �� INSTALLATION
v.N� AUTOMATIC METER READER
FRIDLEY
Address ���-� ���c
Name � 1A,���( S�Uts
Date ��- l3-- �oZ
OId Meter Number 'rJ —1 �
Old Meter Readin �� �Q
Replacement No. E" ��`�
Replacement Reading �
Replacement Make ���
ERT#
Replacement ERT#
Remarks:
1�35�/ Signed:
, � Reqtte�t f+�r�r� �+e�rt
�i�y€�f Fnd�y
� �< �t-�2-��� ��: �arzo�2
� �'�� r��� €�:: w�
��: Wa��r C.�liz,en i+�me: �ar�Se�
A�: G15Lt'6TFt ST t� . ���5
Sch�dEi�ed El�e: 3/13/�Di�1t#�3ti AM� .
i��: R�uef f�tais= kata!/1i1fi
T�:
�i� �n��� � q,q��t �a� y
�
�i� �,����� t �.�C� �,�
����► ���� � ���
ra� ������� �
��-�# �1� .
�
����C��
� -
.
�_ _.___ ___..___�____._ _ _�.____ _rv ._ . �_..__ _ ._�__.__._..___._._1___._. �_________.._ _..___ _.
� �
���= �
� �
�
� �
�__�� � _�_____.___�.____ ______ ________.�_.
. � � « — (
_ �
_ e �._M e._� � ��. �_ �.
City of Fridley
Water Department
,
6431 University Avenue NE �
Fridley,MN 55432 � r'
(763)572-3566 �'
��We fiereby authorize the City af Fridtey andior its
emp{oyees to do what is necessary to replace the water meter. {understand that the property owner
is liable for the water line from the main ta the premise and alt iriteriur plumbing. (Per Gty code
402.06) t also hold the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to inctude,but not limited to;valves,piping,walls,floors or the curb
' stop box and service line. 1 understand i am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � 1 c 7�/ ��O —
Name• Address� CJt��` \��� ��
Phone Number: Date: `� ��
�- '�.,
Signature:
. Witness Signature:
FRIDLEY C1TY CODE
CHAPTER 402.WA7ER,STORM WATER,AND SAPIITARY SEWER
ADMINtSTRATION
(Ref Ord No 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 any house
or building for which the application is made,the owner or contractor shali be required to obtain a permit for such
connection,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 shall be noti�ed. {t shatl be unlaaufu!to cover any connecting tine untii 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 CONNECTiON
After the initial connection has been made to the water service curb stop box or the sewer tead at the property
fine 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 shaU 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 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 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 iine from the premises to the main including debris ctearin�or root cutting and to maintain the
water service curb stop box for operability and at such height as wiN ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)