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City of Fridley
� ' Water Deuartment
. Address b/�� ��l �'[ -
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Name � �h�,t,S �ddt,d�Ct, __
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Date �"r -- � �'
' Old Meter Number ��
Old Meter Reading � �/,C� '
Replacement No. �c� / 7� 3 4 �
Replacement Reading � ;
Replacement Make �S�.�r..t.�-.-
.,, Remarks• 5�.��►� ��'�-�- :
Signed
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u�nroF AUTOMATIC METER READER
FRIDLEY
Address If.���l ` �C�'��" `��
__ Name��Y1� t�4�C3�
Date �-���— `�
Old Meter Number �
Old Meter Reading �
Replacement No. .. _ ����4���`(
Replacement Reading �
Replacement Make_'��
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Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
IJwe hereby authorize the City of Fridley andjor 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 ali interior plumbing. (Per City code
402.06) i also hold the City of Fridley and/its employees ha�mless for any damages that may occur
while doing this operation. This to include,but not{imited to;valves,piping,walis,floors or the curb
� stop box and service line. f understand f am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) O 6� "��v v
Name• Address: ���' � v?� ��
Phone Number: Date: 1`I V��� .
Signature• - �
. Witness Sigt�at
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINIS7RATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1156, 1191)
402.Q5. PERMIT FEE
Prior to constructing or repair of any water or sewer fine connecting the existing municipal system and anj+house
or building for which the appiication is made,the owner or contractor shall be required to obtain a permit for such
connection,and shatl pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shaif be noti�ed. It shail be unlawfut 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 suitabte 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 lead has been extended to the property line for cannection,the applicant,owner,
or the occupant or user of such premises shal�be tiable 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 shatl be charged for the costs of the
maintenance and/or repairs, inctuding any necessary street repairs,at a rate set anr►ua{ly by an administrative
policy. It shall be the respansibility af the applicant,owner,occupant os user to perform standard maintenance of
the sewer service fine from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box for operabitity and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)