Meter Swap ��'�s-4 �S 1 ��
�� ��--�''� INSTALLATION
cmoF AUTOMATIC METER READER
Ft�n«r �
j ' J \ T
Address �`t ; "^ ��� `— �
Name �'�'�'N� ��•`�i..�
Date �-�`��
Old Meter Number � �
Old Meter Reading � �Jl
Replacement No. "7�Jr� ����
Replacement Reading QS
Replacement Make
ERT# �������
Replacement ERT#
Remarks:
l3a-S Sianed: �, :
� - €���t fc�nr '�rvria� R
�i�y a�f �rici�
� �. ��-�rt-.� ��: T�.rrr�n��
T�e= �M€�� �€.
. Wat� ��ae� �nd�
�dd�ss: 6�tQ S�TH AVE� . �7�-T33f �
S�d[�t+e= 1��1 9�Q!� •� �+op�jr t�:
_ f� = ta��iN!M�
.
Ai�n 7ak��
� t'N�7 � ' `'�-- t\�;���
�
�
�
���-�_ 3�`��5�. 3
�����r��- 3a�1 �3� �
N�' ��-�-- ��� a`�6b
�� �}� -�
�-� � — ������t,
,
�__�����.� _ � _.��__�_.�---._-________� ___�� _______..
t[
.. t...._.�._.. __..�."' .�_._"....�.._.__�.�..�..-. '_'-'._......_..
. �
. � k......._..._._............._......._.______..._.�..__._.,,,,._. .._.. ._._..._. _______.
� � ��` ' � � ��� �
. �_�:.`�_�-:�� .__ ._..
. "
Gty af Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
��We hereby authorize the City of Fridley and/or its
empioyees to do what is necessary to replace the water meter. 1 understand that the property owner
is tiabte for the water line from the main to the premise and all interior piumbing. (Per City code
402.06) t a{so hoid tfie City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to incfude,but not iimited to;vaives,piping,walls,floors or the curb
stap box and senrice line. I understand i am also required to obtain a permit prior to any work,if
necessary. ���
Final meter reading(oid meter�
���
Name• Address• �v l�����
Phone Number Date• '��� -
� o�.� G�������2�U Y�/
Signature: (�c�^✓
Witness Signature:
FRIDLEY CITY CODE
CNAP7'ER 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. PERM{T fEE
Prior to constructing or�epair of any water or sewer line connecting the existing municipal system and arry house
or building for which the application is made,the owner or contractor shall be required to obtain a permit for such
connection,and shail pay a permit fee as provided in Chapter 11 af this Code. After such connection has been
made,the Water and 5ewer Department shall be notified. It shatl be unlawfut to cover any connect+ng line until an
inspection has been made and such connection and the wark incident theseto has been approved by the City as a
proper and suitable cannection.
402.06. REPAtRS AND MAINTENANCE TO CONMECTiON
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�epairs 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 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�esponsibility of the app4icant,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 witl ensure that it remains above the f+nished
grade of the land or property. (Ref 638,1156,1191)