Meter Swap 1�r�� I�-�y���
�� �'�'"�� INSTALLATION
G.�,� AUTOMATIC METER READER
Ft�n��r
Address � � lO� - ��-'"`��
Name f-�t11 �C�-t C.�'�
Date ��' �����
Old Meter Number � ��`
OId Meter Reading Q �{ ��
Replacement Na ��PY'"��Q#�S ��
Replacement Reading �
Replacement Make ����
ERT# ��1������ V
Replacement ERT#
Remarks
�0� Signed:
F�+eq�# f+�r�r� Ft
.
� �i�yr c�f Fr�di�t
T� �: �1-t1-�'1� ��: 1�11
T�per ,I�MF��er � H�� YVa�yr '
E��: tA/��r �Cliz�n�� �S�
,Addrp.s�: S�flCt 4TF1's`T!� _ 763-�i�[I-�04$
[l��e= l�f'75�it1 �3D AM� �
1�[1e€a�: fieqt�at E�ta�: k�a!lli�t
�
�� �� _ ._ ��. _._ _..._ ._�__ .. _ �. ____ . ,mm�w_ � � ..��W .._ _ _ . _�__�.m._ _.____._�_� ._._ _._._.m___._�..
Ai�r�T;��
�v �'�
��
�
�
�
�m�-��.- i�1�5`1 �a
��,o��a��� - n(��(0��C�
lu�`GJ 1►'�����-�n��
�l� �L�- � �
�� � �- ��q �a��
� _ �
����__ .�� _ .�__�.��__ ____.
� 3
� __ _._ ___ ___ �
��. �--- �
�
� 1��� .L�--� �_ _ � �
r
City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley andior 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 hoid the Gty of Fridley and/its employees harmiess for any damages that may occur
white doing this aperation. This to inc{ade,but not limited to;vatves,piping,walls,floors or the curb
stop box and service line. I understand 1 am also required to obtain a permit prior to any work,if
necessary. ^ �
Final meter reading(old meter) � �J�� l � �
'� , y��
Name� Address•_�T t�� ��i-
PhoneNumber: _Date: �� � �\
�, �
Signature:
Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATI�N
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191)
402.05.PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipat system and any hause
or building for which the apptication is made,the owner or cont�acto�shali 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 untit 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.Q6. REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service cu�b stop box or the sewer lead at the property
line or a water sesvice or sewer 4ead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shail be liable for all repairs required to any water line and sewer lines
necessary for connection of the premises from the main to the premises. If the property owner requests
maintenance service or�epairs 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
poticy. tt shall be the�espansibility 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 curb stop box for operability and at such height as wili ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)