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Gn� AUTOMATIC METER READER
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Name � ���
Date �""��— ��
Old Meter Number � L�
Old Meter Reading �
Replacement No. ���
Replacement Reading �
Repiacement Make ����.
ERT# �� �✓3����/
Replacement ERT#
Remarks:
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City of Frid{ey
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
IJwe hereby authorize the City af Frid{ey andJor its
empioyees to do what is necessary to reptace the water meter. I understand that the property owner
is fiable 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 harmless for any damages that may occur
while doing this operation. This to include,6ut not limited to;valves,piping,walls,floors o�the curb
� stop bax and service line. t understand i am also required tu obtain a permit prior to any work,if
necessary.
Final meter�eading(old meter) ���� ��
Name• Address• �,,�(J`^ �� JT
Phone Number: Date:_ ��I ✓, �
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, 1144�1156, 1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipai system and any house
or buitding for which the application is made,the owner or contractor shall 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 notified. It shali 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. 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 tead has been extended to the property fine for connection,the applicant,owner,
or the occupant or user of such premises shatl be-tiabie for all repairs required to any water fine and sewer lines
necessary for connection of the premises��f�om 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 casts 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 ar user to perform standard maintenance of
the sewer service line from the premises tn the main including debris clearing or root cutting and to maintain the
water service curb stop box for operability and at such height as wili ensure that it remains above the finished
grade of the land or property. (Ref 638,1156, 1191j