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city of Frialey
water Department
Address �� �S �y.��'� C.�
Name �. t, ��,�,, �
Date > `� � � o �
Old Meter Number ����^� ��
Old Meter Reading � � � �
� Replacement No. �--''���,3 �.�
', Replacement Reading �
' Replacement Make .��, _
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Signed
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G.N� AUTOMATIC METER READER
FRIDLEY
Address ����� �'���-'L'�
Name ��-��'1�i�f_��v 1'"J�-T l-�
Date �'4�- (�
Old Meter Number � �� � --�U�
Old Meter Readin ��� ��
Replacement No. SP�"�+c'�� ��"�� �
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
I/we hereby authorize the City of Fridley and/or its
employees to do what is necessary to replace the water meter. 1 understand that the property owner
is liable for the water line from the main to the premise and all interior piumbing. (Per City code
402.06j I also hold the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to inciude,but not limited to;val�es,piping,walis,floors or the curb
� stop box and service line. 1 understand 1 am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter)��_,�+�—J ����
Name: Address: ��0� UtUt�.1L�
Phone IVumber: Date: ��`���
Signature• C�.J'�--�
Witness Signature:
FRIDLEY CITY CODE
CHAP7ER 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 to constructing or repair of any water or sewer line connecting the existing municipal system and anjr house
or building for which the application is made,the owner or contractor shafi be required to obtain a permit for such
connection,and sha11 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. It shaN be unlawful to cover any connecting line untif an
inspection has been made and such connection and tMe work incident thereto has been approved by the City as a
proper and suitable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTION
After the initlal 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�Ine 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 shafl be charged for the cnsts of the
maintenance andlor repairs, incfuding any necessary st�eet repairs,at a rate set annualty by an administrative
palicy. lt shall be the responsibility of the app{icant,owner,occupant or user to perform standard maintenance of
the sewer senrice line from the premises to the main inctuding debris clearing ar root cutting and ta maintain the
water service curb stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
Request Number: 10793
Publie Works Division
Service Request
Problem Address: 5705 Quincy St Requested By: Sandi H
Department: WA1ER Address: No adckess provided
Problem/Issue: FINAL METER READING Phone Number:
Scheduled Date: Scheduled 1lme:
ACTION NEEDED:Fina1 reading.Clos ng 11l20l15 E T#33284257
Createdby: WendyHiatt DateCreated: 2015-11-09
ACTION TAI�N:
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Status: In Progress Resident Contacted ❑
Date Completed: Completed by:
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