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� Name
Date l ��� r w
Old Meter Number ��� J� c.7 S y
Old Meter Reading 3 8 g � �
Replacement No. � 11 � ' 3 � ��
Replacement Reading �
Replacement Make ��q�.l'"
Remarks: � h�
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Signe
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c�.noF AUTOMATIC METER READER
ERIDLEY
Address (� l,�� "' ��� �(
Name z�C�1t�y ����Li`
Date �' 1'-t�
Old Meter Number "'f, `! ��
Old Meter Reading �
Replacement No. `'�mE ����'��Y
Replacement Reading �
Replacement Make d.��'�1��-
ERT# � 7`7�� V_Z� � i�
Replacement ERT#
Remarks:
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City of Fridiey
Water Department
6431 Uni�ersity Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley and/or its
employees ta 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 ail interior plumbing. (Per City code
402.06) i also hold tF�e City of�ridley and/its employees harmless for any damages that may ouur
while doing this operation. This to include,but not limited to;valves,piping,walis,floors or the curb
' stop box and service line. 1 understand I am also required to obtain a permit prior to any work�if
necessary.
Final meter readin old meter O ��f �
B� �
Name� Address• 1/�//1k.�V ����
Phone Number: Date: J� '� .
�
Signature•
Witness Signature:
FRIDLEY CITY CODE
CHAPTER+402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1156, 1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anq house
or building for which the appiication 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 shall be unlawful to cover any connecting Ilne 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 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 line for connection,the applicant,owner,
or the occupant or user of such premises shall be liable for all repairs required fo 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 and/or repairs, inciuding any necessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant or user to perform standard maintenance of
the sewe�service line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box for operabifity and at such height as wili ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)