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F�a�r
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Name����1J �IAT�
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Date 'l�—��,
Old Meter Number
Old Meter Reading Q
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Replacement Reading �
Replacement Make ��G���"�''� _ _
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Remarks:
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City af Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)57Z-3566
i jwe 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 liabte for the water line ftom the main to the prernise and al!interior ptumbing. (Per City code
402.06) 1 also hold the City of Fridiey and(its empioyees harmless for any damages that may occur
white doing this aperation. This to intlude,but nat timited to;vaives,piping,walis,floors or the curb
stop box and service line. 1 understand 1 am also required to obtain a permit prior to any work,if
necessary. � �
Final meter readin old meter) � ` � � —
gt
Name� Address: ��
. I_�_�-\�__� >:
Phone Number• Date�
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Signature:
Witness Signature:
�RIDLEY CITY CQDE
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. PERMIT FEE
Prior to constructing ar 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 shaU 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 shalt be uniawful to cover any connecting line until an
inspection has been made and such tonnection and the work incident thereto has been approved by the City as a
praper and suitab{e connection.
402.06. REPAIRS AND MAtNTENANCE TO CONNECTION
After the initial connection has been made to the water service cu�b stop bax or the sewer lead at the property
line or a water service or sewer lead has been extended tothe property line for connection,the appficant,owner,
or the occupant or user of such premises shafl be liable for ail repairs required to any water tine 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 shail be charged for the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annual{y by an administrative
policy, tt shall be the responsibility of the app4icant,owner,occupant or user to perform standard maintenance of
• the sewer service line from the premises to the main inctuding debris ciearing 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 fand or property. (Ref 638, 1156, 1191�
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