Meter Swap � ��� `�3 INS ALL�ATION�
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��.�,� AUTOMATIC METER READER
FRIDLEY
Address ��(d"{ � �---�`T'a'�
Name �1J �l 4�ELS�`7�.�
Date � 1 —1�'`�
Old Meter Number 3c5�� ��
Old Meter Reading �
Replacement Na "rJ� c�p� �o�
Replacement Reading �
Replacement Make �P�'�(�
ERT#__� � �� 1
Replacement ERT#
Remarks:
?�� Signed:
�.�''`�
, Reque�t fvr Serv�c� Repvrt
� Ci#y vf Fritiley
Referen�e Idca: �t-7 t-3� Qa�e: to.rz7�'ot t
R�equeat T�rpe� hatall AMR met+er Entered By: W�r F�att
C�partmerrt: Y�ater Crtizen(��n�: Pat#y
Ac�eas� 59M64 7�H ST NE Ca�adc Phvn�: G12-�M1'4�-it,326�
,�d�duled O�ate= 11/1l2D11 11=00 A��� ' Prca�e�ty�wner [k�T}�eisen
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Loca#iar�Deta�s: Request Uetail�= tr�atai('A#MR
,4�tion T�k+en:
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Respan�e Person: �
App�v�:
�etic�n C?ate: —._.______ '� t�izen idotfied
11 -1 -c`
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City of Fridley
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe ���'�'� c;c� � � �`��q���hereby authorize the City of Fridley and/or 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 hold the Ciry 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 obta.in a permit prior to any work, if necessary.
Name: �W�r .L; c:� � �1J�r�0�l'�\ Address: � "� 6 � �j.l 5`F � hf �
Phone Number: (o� �- '°)l� � 3�� Date: I � I I
Signature: �Q��/�l " �"��""
Witness Signature:_f�
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SAlYITARY SEWER
ADMINISTRATION
(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 e�sting municipal system and any
house or building for which the application is made,the owner or contractor shall be required to obtain a
permit far such connection,and shall pay a permit fee as pravided 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 untii an inspecrion 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 A.ND 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 requixed 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 maintenance services or repairs be performed by the City,the properly 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 perfortn 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 sueh
height as will enswe that it remains above the finished grade of the land or property. (Ref 638, 1156, 1191)