Meter Swap '� ��j�-�r����
� U��'�� INSTALLATION
cmroF AUTOMATIC METER READER
F�a�
Address �l�!� !' Ibc��-�: ��'` �
r
Name ��r„� � �.������
Date l,�—��"�,�
Old Meter Number y �
Oid Meter Readin �� 1�
Replacement No. ��'"� ��� �_
Replacement Reading �
Replacement Make �
ERT# ���� —L� � �
Replacement ERT#
Remarks:
(�3� Signed:
- � ��II�S� fiN"�i'�ti(� F��
�:i�y t�f Fridl�y
i�eF !�� �t-t1-� ��: 12,�12i20i�
�T�ae� �a�A�� �. �.
I�p�: Wat� ��� Tc�#�
Add�� � l.1410E�i#!� _ 7fi3�71-�44
��e: i2/1�17 71�Q 1�i �� P�op�edjr 43�r�:
N �
��: i�eque�t taeta�s= id±a�ll�i
��/
Ta�=
� ' �� ����
' I�
;
a� ,�-rt��- ���1'� � �b
ot c� �e��,.�,-- p�t`1 `��C�
�
1.��--c� ���tr-�2� - ��,g�.v�
������U^ �
. �-�z-r � - 3��� �G� ��O
� : i .
��._ _� �_�e..�_.. _ ___________�.______..�.�______.__..�._�_._
_
. � � _� �
�.���� _���� _ ._ __ __�
.
City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
ti/We hereby autfiorize the City of Fridtey and/o�its
employees to do what is necessary to replace the water meter. 1 understand that the properly owner
is{iable for the water line from tfie main to the premise and all interior plumbing. (Per City code
402.06) I also hold the Gty of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walis,f{oors or the curb
stop box and service iine. 1 understand I am aisa required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � �� � ��
Name: Address:, �(�� b` �����`�
Phone Number. Oate: ��7�_ `���� -- —
Signature•
Witness Signature: _p-�,L_����k,
FRIDLEY CtTY C4DE
CHAPTER 402.WATER,STORM WATER,AND SANiTARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1155, 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 apptication is made,the owner or contractor sha{I be required to obtain a permit for such
connection,and shalt 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 shail be unlawful to cover any connecting line until an
inspection has been made and such connection and the wark incident thereto has been approved by the City as a
proper and suitabte connection.
402.06. REPAIRS 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 connection,the applicant,owner,
or the occupant or user of such premises shall be liable for ail 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 andJor repairs, inciuding any necessary street repairs,at a rate set annuaity 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 fram the premises to the main including debris ciearing ur raot cutting and to maintain the
water service curb stop box for operabifity and at such height as wilf ensure that it remains above the finished
grade of the land or property. (Ref 638,1156, 1191)
Ft�uest for �er�ic� R+�por�
City of Fndley
� �: s�z-rt2-�a�� t��: a,�tsr��2
� T�pe� Seirer h�ack-�q chedc�it�r� �k+�ed By: WendY��i
t�p�tment: Sew� �tizt�i��ne: Tc�n Hav�ca
Rddreu= 5$2�Ml'3(�RE LAKE QR W Caflback Phcane: 763-�7t-7�k44
Sc�eduF�d Date= ��(�r:
l�catitx��+e#a�s: F�iest Detals= Bada�p_ (}radc C.�t�►Main
A�T�'i:
�
I i
� ��� G� �
� �
�J7 ►'�:,►., �r� �
� �
;
i
I
E
��fSCM'1: i
� �,�5 __ G ���� _ _ _
��:
_
���,�: __ _ _ _ �� �
� �- r�-�Z
R��#fc�r�en+►ita� Ft��r#
Ci#y c�f Fricil�
. �: �-��-�� ��: ae��a��2
TjEpe� Se�er 6aek-up+ched��� ��'�r� F�t
�e�t. � Cid�a��+�me� Tcar��
Ad�: 5�t0�L/i1iE GEi 119C �c P�re: 7�1-�k4d
�+e: _
!a�€��: ��Eae�s: Bada�_ C�treidc#3�lian
� _
�{��_ �€�
�
�
_ �
�... _...�.� ___._�._._....._._�.......... �...�.
�� i��
_
�
nn _ ��12 7:3�i4�4 �