Meter Swap '� ��-�'�- J ��7 a-t;�5��i��v
� INSTALLATION
�.n,� AUTOMATIC METER READER
FR[DLEY
Address l(J�� t `' �;� �(
Name 1�b�1:� �(�`X�N
Date �- �t�+.
Old Meter Number i �
Oid Meter Reading , L{
Replacement No.
Replacement Reading � _
Replacement Make '�
ERT# �,��i r�. �
Replacement ERT#
Remarks
R��g Signed:
• R�quest f�r '�e� �i�p�rt
��i arf ��ti{�y
i� �€ac �1-12-�4� �e: 3,��12ii12
Tj�ee� t�a�'hM��aet�r �r:
�e�k: Mla� C.�Eir,��: ,d�in�
Ad�: 5191 6TH ST t� . !612-29iB-616�
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City af 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 tine from the mai�to the premise and alt interior plumbing. (Per City code
402.06) i aiso hold the City of Fridley andJits employees harmless for any damages that may occur
while doing this operation. This to include,hut not limited to;valves,piping,uvalls,floors o�the curb
� stop bax and service fine. I understand 1 am also required to obtain a permit priar to any work,if
necessary. � ���
Final meter reading(otd meter) � ��
Name� Address:
�l�l �(��T"��T
Phone Number: �� _�
`�---....
Signature:
Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER �
ADMINIS'fRA71UN -
(Ref Ord No 113,464,565,566,624,638,662,922,988, 1144,1156, 1191�
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anq hause
or tiuilding for which the application is rnade,the owner or contrador shall be required ta obtain a permit for such
connectian,and shali pay a permit fee as provided in Chapter 11 of th9s Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shalt be uniawful to cover any connecting line unti{an
inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.Ob. REPAIRS AND MAINTENANCE TO CONNECTION
After the initial connecCion has been made to the water service curb stop box or the sewer fead 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 shati 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 performed by the City,the property owner shall be charged for the costs of the
maintenance and/or repairs, inciuding any�ecessary street repairs,at a rate set annualty by an administrative
policy. ft shal{be the responsibi{ity of the appticant,owner,occupant or user to perForm standard maintenance of
the sewer service line from the premises to the main includin�debris clearing 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 land or property. (Ref 538,1156,1191}