Meter Swap � ���� INSTALL.A ION�v
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��.��. AUTOMATIC METER READER
FRIDLEY
Address �IC�� `- ��� �"?�
Name I SP!��~� 1����
Date � t�� ' t—�
Old Meter Number ��
Old Meter Reading � 1'{ q �
Replacement No. o��
Replacement Reading l!�'
Replacement Make
ERT# ��,�� �� y � '
Replacement ERT#
Remarks:
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City of Fridiey
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
1/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 line from the main to the premise and all interior plumbing. (Per City code
402.06) i also hold the City of Fridley and/its empioyees harmless for any damages that may ouur
while doing this operation. This to include,but not limited to;valves,piping,walis,floors or the curb
' stop box and service line. I understand i am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) �� �^� 1�
Name� Address• �a�� ` ���<
Phone Number: Date:_ �_.���'�
Signature:
Witness 5ignature:
� FRIDLEY Cfl'Y CODE
CHAP7ER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144, 1156, 1191j
402.05. PERMIT�EE
Prior to constructing or 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 shall 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 VVater and Sewer Department sha{f be notified. {t shal{be unlawful to cover any connecting line unti{an
inspection has been made and such connection and the wark inc+derrt thereto has been approved by the City as a
proper and suitabte connection.
402.06. RERAIRS AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water service carb stop box or the sewer lead at the property
iine or a water senrice or sewer lead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shalt be fiable for alf repairs required to any water fine 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, including any necessary street repairs,at a rate set annually by an administrative
policy. it shall be the responsibility of the applicant,awner,occupant or 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 operability and at such height as will ensure that it remains above the finished
grade of the land or property. {Ref 638,1156,1191)
' � Request for �ervice Ft+e�rt
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Adciess= +6260 7TH ST NE C�ad€F�cxie: 7ii3-�71-1�4
Sc�duled Date: 2/14/'�Ol�1t1�0I}pM �� Pt�pe�y�wner:
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