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Name��f �S��A/1 JGY�T�/1i��
Date � '�� ✓Q� '
OTd �I�ter Number �� � '
O1d Meter Reading �
Fteplacement I�o. �a � ����
Replacement Reading
Replacemerit Make �j A.��er
Remarks: ��
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SignedJ
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� INSTALLATION
�n,� AUTOMATIC METER READER
FRIDLEY
Address IQ� � �\���
Name ��R��T l,Qe) Jc1�4l�1�
Date �l—�,��
Old Meter Number "�J
Old Meter Readin �
Replacement No.
Replacement Reading �
Replacement Make �
ERT# �J�� � i ��CJ
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. i understand that the property owner
is liable for the water line fram the main to the premise and all interior piumbing. (Per City code
40Z.06) i also hold the City of Fridley and/its employees harmless for any damages that may occur
while daing this operation. This to include,hut not limited to;valves,piping,walls,fioors or the curb
� stop box and service line. i understand i am also required to obtain a permit prior to any work,if
necessary.
Ftnal meter read�ng(old meterj �
��`�,����
Name: Rddress: ��� —
Phone Numb • Date: ���� '� - --
Signature:
. WitnessSignature: ����"�r17`"`�
FRIDLEY CITY CODE
CHAPTER 40Z.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord Na 113,464,565,566,6�9,638,662,922,988,1144,1156,1191)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anq house
or buildi�g for which the application 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 line until an
inspection has 6een 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 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 connection,the applicant,owner,
or the occupant or user of such premises shall be liable for all�epairs required to any water line and sewer lines
necessary far cannection 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, including any necessary street repairs,at a rate set annually by an administrative
po(icy. 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 operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191�