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Date 1G3"`1� �,�
Old Meter Number ��
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- City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
IJwe hereby authorize the City af Fridley and/or its
employees to do what is necessary to repface the water meter. i understand that the proQerty owner
is tiabte for the water line fram the main to the prerr�ise and all interior plumbing. (Per City code
40Z.06) I a{so hold the City of Fridley and/its employees harmless for any damages that may occur
white dang this operation. This to include,but not limited to;valves,piping,walis+flaars or the curb
� stop 6ox and service line. i understand!am alsa required ta obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) �� ``� '
Name: Address:_ `���Q `–�''�' "��"� —
Phone Numher: . Date: �M�i�`� •
Signature:
. Witness Signature: .
' FRIDLEY CITY CODE
CHAPTER 402.WATER,STQRM WA7ER,AND SANITARY SEWER
ADMINISTRATICIN
(Ref Ord No 113,464,565,566,629,638,662,922,988.1144r 1156, 1191)
402.05.PERMIT FEE
Prior to canstructing or repair of any water ar sewer line connecting the existing municipal system and any house
or buiidi�g 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 Water and Sewer Department shall be notified. It shait be unlawful to cover any connecting line until an
inspection has been made and such connection and the work incident thereta has been approved by the City as a
proper and suitable connection.
4U2.46.REPAIRS AND MAINTENANCE TO Ct7NNECTlON
After the initial connectian 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 accupant or user of such premises shall be liable for all repairs required to any wate�line and sewer lines
necessary for connection of the prernises from the main to the premises. If the property owner requests
maintenance service or repairs be performed by the City,the property owner shali he charged far the costs of the
maintenance and/or repairs, induding any necessary street repairs,at a rate set annual{y by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant or user to perform standard mainteaa�ce of
the sewer se►vice fine from the premises to the main 9ncluding debris clearing ar root cutting and to maintain the
water s�rvice curb stop box far ope�ability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191j