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FR[DLEY
Address � �--� 'S
Name -� � � :�� �*�
Date u— � �--��.
Old Meter Number `���7
Old Meter Reading t� �
Repiacement No. «
Replacement Reading Sv
Repiacement Make ^
ERT# � tt7 `
Replacement ERT#
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- City of Fridley
Water Department
6431 University Avenue NE
. . " Frid{ey,MN 55432
(763)572-3566
��We hereby authorize the City of Fridtey and/or its
empioyees to do what is necessary to repiace the water meter. {understand that the property ownec
is liabte for the water line from the main to the premise and a!I interior plumbing. (Per City code
402.06) 1 also hold the City of Fridley andjits employees harmless for any damages that may occur
while doing this operation. This to include,but not iimited to;vafves,piping,walis,ftoors or the curb
stop bax and service line. I understand I am aiso required to obtain a permit prior to any work,if
necessary. ��
Ftnal meter readjng told meter�
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�_�-�-� � ,
Name� Address�,.r�.� ` o
Phone Number: Date: ��_��` ��
. �� .
Signature:
Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WA7ER,ANO SANiTARY SEWER
ADMINISTRATf�N
(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 cannecting the existing municipal system and any house
or building for which the application is made,the owner or contractor shalf be required to obtain a permit for such
connection,and sha{t 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 shail be unlawful to cover any connecting line until an
inspection has been made and such cannection and the wo�k incident thereto has been approved by the City as a
propec and suitable cannection. °
A02.06.REPAIRS AND MAfNI'ENANCE TO CONNECTI4N
Afterxhe 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 fead has been e�ended to the property fine 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 sewer lines
necessary for connection of the premises from the main to the premises. if the property owner requests
maintenance service or repairs be perfarmed by the City,the property owner shali be charged for the costs of the
maintenance and/or repairs, includtng any�ecessary street repairs,at a rate set a�nually by an administrative
policy. It shali be the responsibility of the applicant,awner,occupant or user to perform standard maintenance of
• the sewer service{ine from the premises to the main inc4uding debris clearing or root cutting and to maintain the
water service curb stop box for operability and at such height as wili ensure that it remains above the finished
grade of the tand or property. (Ref 638,1156,1191j