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Meter Swap � J�� INJSTA LATION �YJ ' v.�� AUTOMATIC METER READER FRIDLEY Address ��1 ~ �T�� Name ��,� �V iJ"�"L�y' Date � �—� J�" � 1 Old Meter Number �? �'l�. Old Meter Reading � � � Replacement No. Replacement Reading � � Replacement Make ERT# ��<<"��_�� Replacement ERT# Remarks: ��-�-- Siqned: „� _ l��u�s� fc�r�er� R�por� � �ify flf Fridley Rsfer��PJa�: �1-11-�3 Da�e: 1111�11 F�quest T�tpe� kra�al�/tMR�eter Er��:red€3y: Wendy Hi�t C�ep�trn�: 4Nat+� t�ixen N�e: ."x�san Q�snNey Acldr�ss� 5�851 5TH�T PJE ac��Phone: 7G3�71-t� , .. Scf�dut�d [3ate= 11�'23l2D71 11�/#M �,lV(�C�' P�C)wnee: Locafkic�n Ue#�ils: � Details: ke3ta11 11MR Adi�T�c+en: � �� 7� i 1 � I i �� p�� C��- �"( �°��'�� p j2-c�'�O I�--� ��J� '�� C� � ,U�-� ./n�'��` — �3 5`��l `� � �.�; 2��I�-�G- � ' -� ��`-� �8�� . � ��: ' �`� ��: _ _ ��: _._.__ �€��,t�d l � -a��-� i � . City of Fridley Water Department 6431 Universiiy Avenue NE Fridley NIN 55432 (763) 572-3561 Uwe �i,us c:Y. � �.n�'\�y hereby authorize the City of Fridley andlor its employees to do what is necessa 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 Ciiy code 402.06) I also hold the City of Fridley and/or 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 understand I am also required to obtain a permit prior to any work, if necessary. Name: ��S�h l�. �r�\e�, Address: 5�S�- 5 +h S t /r/C Phone Ntunber: j7� 3 -��/- l y�6 Date: !/- -�3- oZ01/ Signature: Witness ignature: r-� FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER AND SANiTARY SEWER ADMINISTRATION (Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1156, 1191) 402.05. PERMTT FEE 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 to obtain a permit for such connection,and shall 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 line until an inspection has been made and such connecrion and the work incident thereto has been approved by the City as a proper aud suitable connection. 402.06. REPAIRS AND MAINTENANCE TO C�NNECTION After the initial connection has been made to the water service curb stop box or the sewer lead at the property iine 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 line and any sewer lines necessary for connecrion of the premises from the maiu to the premises. If the property 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 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) R�quest for Servioe Report City of Frid�/ Re#er�c�Na: G�-12 Date: 4:+'�3/ZQ12 Rec�uest Tjrpe: Sewer back�p diedc C�7►n�ain Errtered By: Wendy}�att [�p�trrn�t: 5ew�r Gitiz�vr N�e: S+us�xr Acic�ess� 5851 5TH ST NE adc�one: 651-6�3-19�a5 Sc�e�i [)ate= Peaper#y C3�r: L+�ca�ic�n{7+�#�s: � ��_ ��R- ��l► � A�tiar�T�cren: �______��_ _.__.__� _ —_ --- i � i ��(.�e J �i-°�� I�V�;✓-• ('tl( �c,/ ` � ,� �,,,�` c i �t �,�,.� � —�1�.� �..C�� G�� I;►-�.-�, , l�f�� o `�� , 5 � . i ' � ' � � � � � � � ; � � � � � � � � � � � � � � _______ . __ _ _ _._____.___r _.________..__ -__�� ,�P�: !--��!�,�5 C !"N��'. ��: _.. _ . ___.__ _ _ _ C��Date: " �� '�-�3- tZ FF��t�t f+�r�rv►ic� �+�art Ci�c�f �rici�:y '' "�nee�n: -12 il�k�: 4��2 Tj�e� Sew�er ba�c-�up�dc�n� � �y� W �p�: Se�r ��i�e: �� = 5�`I 5TH�T� fi��: �51-�6:#3-��5'5 date: . �Detais: Rfe�ieat 0�: Bari��_ �rec�c t�Ma� Ae�n T�n. {�Y " � P# _ T�Z#�s�'��sara. ��c�et�6ff�F�sira�� t � � � j[J�dc,i�ne� �� ! ��= !�� I . +IJZ�!/2�1��9Aiu� i � «_ __._ _e_ �_........ � � �