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Meter Swap , C%�-'�� INSTALLAT ON�S�J � �.N� AUTOMATIC METER READER F�a� Address � �- �7��: Name ��1L� �7�}1.�1� Date l � � ��`� \ Old Meter Number �� 1 1 Old Meter Reading �� Replacement No. �� a aQs Replacement Reading � Replacement Make �� - ERT# `3330 3 S y� ' Replacement ERT# Remarks: �(�-� Signed: �� - R�uest for S�� R+�por# �iiy of Fridley ��,��: �t-�t-��2 t��t�: 7 t.�ya,+�a�� Tj�e_ k�al� AMR�r�r Ern�d E�r: ��c�r F�� [l�ep��: Wat� C�iz�#�ne: PF�Podany Ael�ess� �r6Q 57TH A1tE NE �ad€PMcme: �63-�7T-� Sc�duled O��e: 11/14J2011 i{k�AM��j� � Pr�rty�: l�oca�ic�n{}��s; � Ueta�$= irrsta�'14MR A�ticm T�c�: � �� ; � ; � 3 I [ � � � I � ` � �t�� `�>9 � 5� 1 � ; c�� - c� `��,'� �360 ; � �,r�--� /�'��(-� � � ��59 �2�� i ti��-� �-�»� -f� I L-�'�� 30 3��1 S � _ _ _ _ --_ __ .. _ ---_ _� ��,�p�,: _ � _ , � ��: � _ _ c�,�,t��: ; � �— ��`�� [�,c��d ' (" . " City of Fridley Water Department 6431 University Avenue NE Fridley N1N 55432 (763) 572-3561 Uwe hereby authorize the City of Fridley a.ndlor 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 City of Fridley and/or its em�loyees hannless 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. ` a�-- �'. S Name: ��C� FI�' Address: � �'�� J � � �� • ��C� Phone Numb •�� ✓�t�/"��7 Date: /�//y�// r Signature: �/,►` Witness Signature: FRIDLEY CTTY CODE CI3APTER 40Z.WATER,STORM WATER AND SANTTARY SEWER ADM.IlVI,STRATION (Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191) 402.05. PERMTT�EE 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 sl�all pay a permit fee as provided in Chapter 11 of this Code. After such cnnnection has been made,the Water and Sewer Department shall be notified_ It shall be unlawful to cover any connecting}ine until an inspecrion has been made and such connecrion and the work incident thereto has been approved by the City as a proper and suitable connection. ' 4D2.06. REPAIRS AND MAIN'I'ENANCE TO CONNECTION After the initial connection has been made to the water service curb stop box ar the sewer lead at the property line or a water service or sevver lead has been e�ended 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 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 r�pairs,including any necessary street repairs,at a rate set annually by an adnvnistrative 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 cuiting 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 G38, 1156, 1191)