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Meter Swap � �a-( �f S--`t7v '� �'�r� `J� INSTALLATfON �� G.N� AUTOMATIC METER READER ERIDLEY Address <�� `t/�L Name � �S'C��2iTy L-t�i�v (ljrp�-TccN� Date �7�-�rf— �� Old Meter Number ` �� Oid Meter Reading o� Replacement No. J� o�� Replacement Reading � Replacement Make (�s��-- ERT# ��_� ��O�� _ ReplacementERT# Remarks: �3�s�- Signed: ��# f�r �ervric�: R�p�c� a ��#y c�f Frid�:y '�; �: fit►1-12-�43� [7h�:e: 3�1f2'�12 Tj�e� ir�ta�Aiil��et+er E�r: ��. Vl�at� �iz�t��ne: t}ay�d� � � ETT�!� � ��= ��a� �� „� t�.sz'�,SZtTY L�vi�s� dP`��auS _ ��= r� � � _ - �� +�Id �'I�t�r# ��;�';� �-�, �� C�id r��din+�: Q��t� c�� ° 1"�1��nr ��#�r� # l��j�j� �� , �� ` j Ne�v �teaciin�: � � �E�� 3��? Q�� ;� � � � � � __ .._____�_� - ; � � ; ��. � _ � � � _ �� _��.. __� , + ' City of Fridley Water Department 6431 University Avenue NE Fridley,MN 55432 (763)572-3566 1/we hereby authorize the City of Fridley and/or its employees to do what is necessary to replace 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) 1 also hold the City of F�idley and/its empioyees harmless for any damages that may occur while doing this operation. This to include,but not limited to;valves,piping,walls,floors or the curb � stop bax and service line. I understand I am also required to obtain a permit prior to any work,if necessary. Final meter reading(old meter) ,_ �� Name: Address. �.JICx� l�,�N�''� �• Phone Number: Date: �=��rl� � Signature:�0 0..��o.. � C�.ln� Q � Witness Signature: FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER,AND SANtTARY SEWER ADMINISTRATION (Ref Ord No 113,464,565,566,629,638, 662,922,988, 1144,1156,1191) 402.05. PERMI7 FEE Prior to constructing or repair of any water or sewer line connecting the existing municipal system and anq house or building for which the application is made,the owner or contractor shait be required�o 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 Water and Sewer Department shali be notified. It shall be unlawful to cover any connecting line until an inspection has been made ar►d 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 ARer the initiai 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 shali be liabie for at(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 and/or repairs, including any necessary street repairs,at a rate set annually by an administrative palicy. It shall be the responsibility of the applicant,owner,otcupant 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 far operability and at such height as will ensure that it remains above the finished grade of the land or property. (Ref 638,1156,1191)