Meter Swap '_ r��"1 '�.�t-tU/�--.�"��ci�les
� L- � INSTALLATION
G.N� AUTOMATIC METER READER
ERIDLEY
Address �.�� �������'Z+ "
Name �v�' �S�'AL��
Date ���J�' ��
Old Meter Number � � l �
Old Meter Reading < <�
Replacement No. ���� ����
Replacement Reading (�
Repiacement Make �1��
ERT# ����IC7�Z� ��
Replacement ERT#
Remarks:
°�Sl�
Signed:
�
d
NQ ( �
C� � '
� �
� � � � � �
I � �
�
� � � �
� � � �
� � � �
� � � � : ;
� �
,
, 3
;
� �
� � i
� � � �
� � � 3
� � � � ;
� �' � � � � _ � '
`�' � � � �
� � � �
� � � !
� � , i �
�.. � � ---,
� ° � � `
� � ; �
`'- .. � I � I
;
� Q �, � �� �
� � � � �
� � � � � '
� � � �- s t � ;
� � � � � � ��
,
� � — � �
� � � � ; � ,
� � ' � � � �
� ^ � c�
� i � � � � � �
� � � � � � �.
� � � �
� � � , �
� � � � t3� � _ � �
� _� �:�;�'
� C7`� � C � ` ______a ,
R w
I �- .�� '} � � ;
3 � �
� � � ' � '� � � °- �'
� :� � �' �
� '� y � �
` q �
� � � � � �
� ...� � �' � � � „ � � �^ �� i .
. . . ...�..._......_.....� _.
.
City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
IJwe hereby authorize the City of Fridley andiar its
employees to do what is necessary to replace the water meter. I understand that the property owner
is liable for the water line trom the main to the premise and ail interior plumbing. (Per City code
402.06) i also hold the City of Fridley and/its empioyees harmless for any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walis,floors or the curb
� stop bax and service line. 1 understand I am also required to obtain a permit prior to any work,if
netessary.
Final meter ading meter) �� �1 ���
� � �Z �
Name� Address: �"'"
Phone Number: Date: . � J``�
Signature:
Witness Signature:
FRIDLEY CITY C�DE
CHAPTER 482.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,1156, 1191)
402.05. PERMIT FEE ,
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and an}r house
or building for which the appiicatian is made,the owner or contractur sha{t be required ta obtain a permit for such
connection,and shaii 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. ft shall be unlawful to cover any cannecting line unti!an
. inspection has 6een made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06. REPAfRS AND MAiNTENANCE TO CONNECTfON
ARer 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 ail 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 far the cnsts 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 user to pe�form 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)
,r.
��—_