Meter Swap , f���Ur�ri -�t����jc;
'� L'`l��`' INSTALLATION
G.nroF AUTOMATIC METER READER
FRIDLEY
Address ���� ���� �7
Name + l�`t� ��1���-s�
Date 1� ��— �,a
Old Meter Number � � � �
Old Meter Reading � C�
Replacement Na �J� 4��-
Replacement Reading �
Replacement Make
ERT# ���� C� C�
Replacement ERT#
Remarks:
�,�` Signed:
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Ad�: 6�,I�BLE ST NE . 7�3-571-�i6
S�uie,d t7at�= 6�22r�t2"E_dio�u1 1��� Pl�ap�f3�r�er:
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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 of Fridley and/or its
employees to do what is necessary to reptace the water meter. 1 ur►derstand that the property owner
is liable for the water line from the main ta 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 occur
while daing this operation. This ta include,but not limited to;valves�piping,walls,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) C�v��J
Name� Address• Iv '�J �'T� s�
' PhoneNumber: Date: �E7� ��` I� �
' Signature: •��"
. Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATfON
(Ref Ord No 113,464f 565,566,629,638,662,922,488,1144,1156,1191j
402.05.PERMIT FEE
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 shail pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Qepartment shall be notified. It shall be unlawful to cover any connecting line untii an
inspection has been made and such connection and the work incident thereto has been approved by the City as a
praper and suitable connection.
402.06. REPAIRS AND MAINTENANCE TO CONNECTION
ARer the initlal connection has been made to the water service curb stop box or the sewer lead at the property
Iine or a water service or sewer 4ead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shall be liable for all�epairs required to any water line and sewer lines
necessary for cannection of the premises from the main to the premises. lf the Qroperty owner requests
maintenance service or repairs be performed by the City,the property owner shall 6e charged for the costs of the
mainCenance and/ar repairs, including any necessary street repairs,at a rate set annual4y by an administrative
policy. It shall be the responsibility of the applicant,owner,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)