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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3556
I/we hereby authorize the City af Fridley and jor its
employees to do what is necessary to rep{ace the water meter. I understand that the properly owner
is liable for the water line from the main to the premise and all interior plumbing. (Per City code
402.06) i also hoid the City of Fridley andJits empioyees harmless for any damages that may occur
while doing this operation. This to inciude,but not limited to;vafves,piping,wa11s,floors or the curb
' stop box and service Itne. 1 understand I am aiso required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � 1�� (�/'`�-�
Name• Address• ���'' �rJ�� f'"�
Phone Number: Date:_„y����� c
Slgnature: � �� � ' — �
. Witness Signature:
FRIDLEY CiTY COQE
CHAPTER�{02.WATER,STORM WATER,ANO SANITARY SEWER
ADMINiSTRATION
(Ref Ord No 113,4fi4,565,566,529,638,662,922,988, 1144,1156,1191)
402.05. PERMiT FEE
Prior to consiructing or repair of any water or sewer line connecting the existing municipat system and anjr hause
or building for which the application is made,the owner or contractor shalf be required to obtain a permit for such
connectlon,and shali pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shafl be notified. ft shail be unlawfut to cover any connecting line 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 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 repairs required to any water llne 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 shali be charged for the casts of the
maintenance and/or repairs, inc{uding any necessary street repairs,at a rate set annuaity by an administrative
policy. it shall be the responsibility of the applicant,awne�,occupant or user to perform standa�d maintenance of
the sewer service line from the premises to the main inciuding debris ctearing 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{and or property. (Ref 638,1156,1191)