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City of Fridley
Water Department
Address ��b� � �� �v�
Name �O�IR �A.1� `
Date ���r��
Old Meter Number
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o1d Meter Reading � ��
Replacement No.
3L �
Replacement Reading
Replacement Make ��1��1'�r
Remarks: �`r
S igned`_ ,`��� .
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� INSTALLATION
G7YOF AUTOMATIC METER READER
FRIDLEY
Address ��1�:��' I� �.J��J�`�e
Name ��.! T����
Date ��`"��
Old Meter Number � � �
Old Meter Reading 1 �-�
Replacement No. ���`�� �
` Replacement Reading ,�
Replacement Make ��x'�
ERT# ���� `� �I ✓
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 da what is necessary to replace the water meter. 1 understand that the property owner
is liable for the water line fram the main to the premise and all interior plumbing. (Per C1ty code
402.06j 1 alsa hold the City of Fridley and/its employees harmtess for any damages that may octur
while doing this operation. This to include,6ut not limited to;valves,piping,walls,floars or the curb
� stop box and senrice line. i understand I am also required ta obtain a pe�mit prior to any work;if
necessary.
Final meter reading(old meter) � ��� �C��
�a �� � �D��'D
Name: Address: —
Phone Number: Date: T,'"��1� �
� Signature:
Witness Signature: . �
FRIDlEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADIVIINISTRATION
(Ref Ord No 113,464,565,566,6�9,fi38,662,922,958,1144,1156r 1191)
402A5. 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 application is made,the owner or contractor shall be required ta obtain a permit for such
se+�ze�Ten,an�shall-;��T�-�prmit fPP a� rovided in Chapter il of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shall be unlawful to cover any connec ing'in �"
inspection has been made and such connection and the work incident thereto has been approved by the C"rty as a
proper and suitable connection.
402.06. REPAIRS AND MAINTENANCE TO CaNNECTION
After the initiat connection has been made to the water service curb stop box or the sewer lead at the Praperty
line or a water service or sewer lead fias been e�ctended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shall be liable for all repairs required to any v�rater line and sewer lines
necessary for connection of the premises from the main to the premises. tf the property owner requests
maintenance service or repairs be perfarmed by the City,the properry owner shall he charged for the costs of the
maintenance and/or repairs, including any necessary st�eet repairs,at a rate set annualty by an administrative
policy. It shall be the responsi6ility of the applicant,owner,occupant or user to perForm standard maintenance of
the sewer service line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box for operability and at such height as will ensure that it remains above the fini5hed
grade of the land or property. (Ref 638,1156,1191�