Meter Swap ��
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Date��_'�=�,/
O1d Meter Number �,�. "
�ld Meter Reading p'
Replacement No.
RepZacement Reading G�
Replacement Make ��/"
Remarks• �i-',/'�'
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Signed
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'� U''� INSTALLATION
�� AUTOMATIC METER READER
FRIDLEY
Address J� 73 ��, ��
Name � v S��t �a�a�4
Date 1�'�� ^ ��
Oid Meter Number �60�7 g 3�
Old Meter Reading �YO 3 �0
Replacement No. S ��r'^�'
Repiacement Reading �
Replacement Make
ERT# 3j �1 S� 63
Replacement ERT#
Remarks:
�7D�7 Signed�� � �
� � Request for Service R+�rt
G�ty a►f Fridley
��,��raa: �t-�t-�t� o��: 7t.r�a»
Request Tppe� Ir�stall AMR�aet�ex 6�te�E�i 8y: W�dy F��t
L3�ep�#mer�t: �laa�+�- C�dxen�lau�ne: Susan K�p�a
,Ad�ess: 58T3 7TM�T NE C�ack Ph�e: 763�72-9�
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Loca�i�Deta�: Fiequ�est Detai[s= kistap �1MR
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City of Fridley
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe 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 from the main to the premise and all interior
plumbing. (Per City code 402.06) I also hold the City of Fridley andJor its employees
harmless for any damages that may occur while doing this operation. This to include,but
not limited to; valves,piping, walls, floors or the curb stop box and service line. I
understa.nd I am also required to obtain a permit prior to any work, if necessary.
Name: Address: S��i� !�� S� -
Phone Number: Date: ��a`��
Si�g�nat+re:
J
Witness Signature: ��
�� r-e�.�a�.3 oa �l 0 3 � U
FRIDLEY CITY CODE
CHAPTER 4Q2,WATER,STORM WATER AND SAiVITARY SEWER
ADMIl�iI�STRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERMIT FEE
Prior to consiructing 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 to obtain a
permit for such connection,and sl�all pay a permit fee as provided in Chapter 11 of this Code. After such
cannection has been made,the Water and Sewer Department shall be notified. It shall be unlawful to cover
any connecting}ine until an inspecrion 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. REPAIItS AND MA.INTENANCE TO CONNECTION
After the inirial 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 e�ended 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 line and any sewer lines necessary for connection of the premises from the main to the premises. Lf
the properly owner requests maintenance services 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 policy. It shall be the responsibility 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 cwb stop box for operability and at such
height as will ensvre that it remains above the finished grade of the land or property. (Ref 638, 1156, 1191)