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Water Deparlment
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City of Fridley
Water Deparlment
6431 Uzuversity Avenue NE
Frid.ley MN 55432
(763) 572-3561
Uwe �b�s�, `�r,v��-� hereby authorize the City of Fridley and/or its
employees to do what is necessary to shut off the water at the curb stop box. I un.derstatid
that the property owner is liable for the water line from the mai.n to the premise. (Per
Cifiy code 402.06) I also hold the City of Fridley and/oz zts employees harmless for any
damages that may occur while doing this operation. This to include,but not limited to,
sod,yard, landscapi.ng,trees, shrubs, driveways, sidewalks or the curb stop box aud
service line. I understand I am alsa required to obtain a permit prior to any work.
Name: SuSar•. �e��F' Addx'ess: '759G La/�Sr l. I�c�z,o� dt��
Phone Number: `1�3-?�kG�-� 8'1�- Date: ���0�Z��Z-
Signature:
Witness Signature:
FRIULEY C1TY CODE
CHAPTER 402.WATER,STORM WATER ANll SAIYITARY SEWER
ADMINISTR.ATION
(Ref OrdNo 113,464,565,566,629,638,662,422,988, 1144, 1156,1191)
402.05. PERMIT FEE
Prior to constructin�or repair of any water ar sewer line connecting the existing mtuucipal system and any
hoase or bu3lding for which the application is made,the owner or contractor shall be required to obtam a
pernoit for such connection,and shall pay a permit fee as provided in Chapter 11 of this Code. Af�er such
connection has been nnade,the Water and Sewer Department shatl be notified. It shall be unlawful to cover
any connecting li.ne until an inspection has been made and such connection and the work incident thereto
has been agproved by the City as a proper and saitable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTIUN
After the initial connection has been made to the water service curb stop box or the sewer lead at the
properiy line or a water service or sewer lead has been extended to the groperty line for c�omiection,the
applicant,owner,or the occupant or oser of such premises shal}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. If
the property owner requests ma.intenance services or repairs be performed by the City,the property owner
shall be charged for the cosfs of the maintenance and/or repairs,including any necessary street repairs,at a
rate set anuually by an administrative policy. It shall be the responsibility of tlie applicant,owner,occupant
or user ta'perform standarc�ma.intenance of the sewer service line from the premises to the main including
debris clearing or root cutting and to maintain the water service c�rb stop box for operability and at such
height as will ensure 13iat it remains above the�nished grade ofthe land or properip. (R.ef 638, 1156, 1191j