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� ��'�`� INSTALLATION
�N� AUTOMATIC METER READER
FRIDLEY
Address ��I — �C����
Name I' ��'P.l�yt�! `�-1 Y��`
Date_ �-��'� ��
Old Meter Number �� �
01d Meter Reading � �) Q
Replacement No. t')3��Ja���
Replacement Reading (�
Replacement Make �
ERT# ��7�Ot,��'?��
Replacement ERT#
Remarks:
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City of Fridiey
Water Department
6431 Universiiy 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 rep)ace the water meter. 1 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 employees harmless for any damages that may accur
while doing this operation. This to include,but not limited to;vatves,piping,walis,floors or the curb
' stop box and service line. i understand i am aiso required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) �� ��� �
Name• Address: �� ` � ��7�
Phone Number: Date: �—��� (� .
Signature:
. Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,488, 1144, 1156, 1191}
402.05. PERMlT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anj!house
or building for which the application is made,the owner or contractor shait be required�o obtain a permit for such
connection,and shail 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 shali be unlawful to cove�any connecting line 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.
402.06. REPAIRS AND MAINTENANCE TO CONNECTION
After the 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 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 ait repairs requ+red 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, including any necessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant or use�to perform standa�d maintenance of
the sewer service line from the premises to the main includ+ng debris clearing or root cutting and to maintain the
water service curb stop box for operabitity and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)