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� U` INSTALLATION
unroF AUTOMATIC METER READER
FRIDLEY
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Name �t�QA '�►\6��S
Date �^� �-t�
Ofd Meter Number � �c
Old Meter Reading ���1
Replacement No.
Replacement Reading �
Replacement Make
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Replacement ERT#
Remarks
t�1�3 Signed:
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City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
IJwe hereby authorize the City of�ridiey andjor its
employees to do what is necessary to repiace the water meter. I understand that the property owner
is fiable for the water line from the main to the premise and all interiar piurnbin$. (Per City code
402.06) i also hald the City of Fridley and/its emptoyees harmiess for any damages that may occur
while doing this operation. This ta include,6ut not limited to;va{ves,piping,walis,floars or the curb
� stop b+ox and service line. i understand 1 am aiso required to obtain a permit prior tv any work,if
necessary.
Final meter reading(old mater) �� �� ��
Name• Address• �� _���Y --
Phone Number: Date:, � U'`L1 r�
5ignature:
Witness Sig�ature:
�RIDLEY ClTY CODE
CHAPTER 402.WATER,S'1'ORM WATER,AND SANfTARY SEWER
ADMINfS7RAT10N
(Ref Ord No 113,464,565,565,629,638,662,922,988,1144,1156,1191)
402.05. PERMIT FEE
Prioc to constructing or repair of any water or sewer line connecting the existing municipal system and any hause
ar buifding for which the application is made,the owner or contractor shalf be required ta obtain a permit for such
connectian,and shail pay a permit fee as provided in Chapter 11 of this Code. After such connectian has been
made,the Water and Sewer Department shall be notified. It shatl be uniawful to cover any cvnnecting line until an
inspection has been made and such connection and the work incident thereto has heen approved by the City as a
proper and suitable connection.
402.05. REPAIR5 AND MAiNTENANCE TO CONNEC710N
After the initiaf connectian has been made to the water service curb stop hox or the sewer lead at the property
line or a water service or sewer lead has been extended to the property tine for connection,the applicant,awner,
or the occupant or user of such premises shal)be{iable for alf repairs required ta any water line and sewer lines
necessary for connection of the prernises from the main to the premises. If the property owner requests
maintenance service or repairs be performed by the�ty,the praperty owner shal{be charged for the costs of the
maintenance andJor repairs. inc{uding any necessary street repairs,at a rate set annually by an administrative
poticy. !t shall be the respon5ibifity of the applicant,awner,occupant or user to perform standard maintenance of
the sewer serv+ce line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stap box for operahitity and at such height as wili ensure that it remains above the finished
grade of the land or property. (Raf 638,1156,1191)