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City of Fridley
,, Water Deoartment
. Address � t ✓ � J x� ��" - , _
. _. . Name t'� d7'�� ���t�. ',
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Date �` ,�-'4,3�
� Old Meter Number ��6 / � ?"T
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Old Meter Reading /3�
' Replacement No.��-� � '���� —
Replacement Reading � '
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'� � INSTALLATION
U.��. AUTOMATIC METER READER
FRfDLEY
Address ��,—" <��� '�c
Name ���� ��S 1 uv'�
Date ���'— ��
Old Meter Number ,� �
Old Meter Reading
Replacement No.
Replacement Reading Q�
Replacement Make l���
ERT# ��� JO a, p✓
Replacement ERT#
Remarks:
�.?�3 Signed:
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 5543Z
(763)572-3566
I/we hereby authorize the City of Fridley and/ar its
employees to do what is necessary to replace the water meter. I understand that the property owner
is liable for the water line from the main to the premise and aH interior plumbing. (Per City code
402.06) 1 also hold the City of Ffldley and/its empioyees harmless for any damages that may occur
while doing this operation. This to include,but nat limited to;vaives,piping,walls,floors or the curb
' stop box and service fine. I understand I am also required to obtain a permit prior to any work.if
necessary.
Final meter reading(old meter) O � �� � ��
Name: Address• ��� ` `I�`�`��
Phone Numb • Date: ���`r_.I;�, ,
Signatur •
Witness Signature:
FRIDLEY ClTY COQE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.05. PERMIT FEE
Prior tv 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�o obtain a permit for such
connection,and shaif 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 shall be uniawfui to cover any connecting line untii an
inspection has 6een made and such connection and the work incident thereto has been approved by the City as a
proper and suitable co»nection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTfON
After the initial cannectio�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 shafl be liabie for aN 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 shal!be charged for the costs of the
maintenance andior repairs, including any necessary street repairs,at a rate set annuaHy by an administrative
policy. It shall be the responsibility af the applicant,owner,occupant or user to perform standard maintenance of
the sewer service line from the premises to the main including debris ciearing or root cutting and to maintain the
water service curb stop box for operability and at such height as witl ensure tfiat it remains above the finished
grade of the land or property. (Ref 638,1156,1191)