Meter Swap � ��� -�f��-�-�v
�� �-� INSTALLATION
v.NOF AUTOMATIC METER READER
FRIDLEY
Address ����'-" �����
Name t`�,� �'bL!'ns���
Date �.� ���"�� �
Old Meter Number 1 �U"1 �
Old Meter Reading � ��
Replacement Na J� �lo� � 1
Replacement Reading �
Replacement Make j���
ERT# �J�J3��,�� �
Replacement ERT#
Remarks:
�oOS Siqned: v
R�ques� fa�r S►�nrice Rep+�rt
' Ciiy af Fndl+�j/
R�ferer�hda: �1-11-� 'Ckake: 1'1l21,�11'
Request T�rpe� �all ANR n�c:ter �ered f3y: VU'endy�Uatt
�arkrr�er�: W�e,e Catizen I�arne: iGen Ha�mm
�� 5�61 7TH ST NE adc F�x�e: 763-5�7493�9
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Sc�uled EE1�e= 11122'1Z017 7_�hM� �, {3wner�
�'(� �—t� Pr°perty
Lc�catiran I��s: F�equest Ueta�s: k�sta�1WR
Acticrn T�n:
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Respans�P�: ��
App�ver:
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City of Fridley
Water Department
6431 Universiry Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe hereby authorize the Ciiy of Fridley and/or its
employees to do what is necessary to replace the water meter. I understand that the
properiy owner is liable for the water line from the ma.i.n to the premise and all interior
plumbing. (Per City code 402.06) I also hold the City of Fridley andlor its employees
harrnless for any damages that may occur while doing this operation. This to include,but
not limited to; valves,piping, wa11s, 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: 1S�„� �v� ?'� v ���. � �•�S c��ddress: �S7 c�i •- > '�' s i, N��' .
Phone Number: �7G3 - S?� • 4.�q Date: l�-- z�� � I
Signature: /� Tlt � y��,.� �
Witness Signature: ��
FRIDLEY CITY CODE
CHAPTER 402,WATER,STORM WATER A.ND SAiVITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565, 566,629,638,662,922,988, 1144, 1156, 1191)
402.05. PERM['T FEE
Prior to constructing or repair of any water or sewer line connecting the exisring municipal system and any
house or building for which the application is made,the owner or coniractor 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
connection has been made,the Water and Sewer Department shall be notified. It shall be unlawful to cover
any connecting}ine 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. REPAIltS AND MAINTENANCE TO CONNECTION
After the initial connecrion has been made to the water service curb stop box or the sewer lead at the
property line or a water service or se�ver 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 auy
water line and any sewer lines necessary for connection of the premises from the main 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 ensm'e that it remains above the finished grade ofthe land or property. (Ref 638, 1156, 1191)