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Signed
UT300I01 CITY OF FRIDLEY CXLIB 1/11/08
, � Customer/Location Consumption History Inquiry 10: 01 : 59
Customer ID: 84655 Name: GLEASON, JIM
Location ID: 496390 Addr: 6360 WASHINGTON ST NE
Cycle/Route: 02 22 Amount due: $ . 00
Initiation date : 5/27/93 Pending . $ . 00
Termination date: 0/00/00 Customer status : A Customer/Location status: A
Type options, press Enter.
1=Select 5=View detail 6=Display comment codes
Service Reading Actual Actual Meter Est Cmnt
Opt Code Type Date Consumption Demand Days Number CD CD
WA REG 9/30/07 19. 00 . 00 92 14102123
WA REG 6/30/07 16. 00 . 00 91 14102123
WA REG 3/31/07 21. 00 . 00 90 14102123
WA REG 12/31/06 20 . 00 . 00 92 14102123
— WA REG 9/30/06 21. 00 . 00 92 14102123
— WA REG 6/30/06 26. 00 . 00 91 14102123
wA REG 3/31/06 21 . 00 . 00 90 14102123
- WA REG 12/31/05 23. 00 . 00 92 14102123 +
F3=Exit F5=Print history F6 Meter inventory F7 Meter svc info
F8=Pending/history trans F9=Budget trans F24 More keys
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FRlDLEY ,
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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 af Fridley and/or its
empioyees 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 plumbing. (Per City code
402.06) 1 also hold the City of Fridley and/its empioyees harmless for any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walls,floors ar the curb
� stop box and service line. I understand I am also required to abtain a permit prior to any work,if
necessary.
Final meter reading(old meter) ���� ��
Name: Address:_ FJ J� �' �''"�"�T�
Phone Number. Date: ��� �t�
5ignature: � � s ���
. Witness Signature: �`�
FRIDLEY CfTY CODE
GHAPTER 4�2.WATER,STORM WATER�AND SANITARY SEWER
ADMINI5TRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402.05. PERMIT FEE
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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�o obtain a permit for such '�;
connection,and shaii 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 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 suitabte connection.
402.05. REPAIttS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service curb stop box or the sewer{ead 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 to any water tine 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 shail be tharged for the costs of the
maintenance and/or repairs, including any n�cessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility of the applicant,awner,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)
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