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Name ��M ��1�L�.�(
Date ������� �
Old Meter Number �
Old Meter Reading �� L WD
Replacement No. !�� ! ;���
ReplacementReading Q�
Replacement Make
ERT# �`����y�
Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 Universiiy Avenue NE
Fridley,MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley andjor its
empioyees to do what is necessary to reptace the water meter. I understand that the property owner
is liable for the water line from the main to the premise and al{interior plumbing. (Per City code
402.06) t also hotd the City of Fridley and/its employees harr►�less for any damages that may occur
while doing this operation. This to include,hut net limited to;valves,piping,�nralts,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 reading(old meter� �� ���
Name• Address• I/�I r i���7
Phone Numb Date� �—� c7`��.� ,
�
Signature•
. Witness Signature:
�RIDLEY CITY CODE
CHAP7ER 4Q2.WATER,STORM WATER,ANO 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 or repair of any water or sewer line connecting the existing municipal system and any house
or buitding for which the appiication is made,the owner or contractor shall be required to obtain a permit for such
connection,and shall pay a pe�mit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be noti�ed. It shali be unlawful to cover any connecting pne until 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.
402.05. REPAIRS AND MAfNTENANCE TO CONNECTION
After the initia!co�nection has been made to the water service curb stop box or the sewer lead 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 shall be liable for ail 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 andior repairs, including any necessary street repairs,at a rate set annuaity by an administrative
policy. It shall be the responsibility af the applicant,owner,occupant ar 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 operabifity and at such height as will ensure that it remains above the�nished
grade of the land or property. (Ref 638,1156, 1191)