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'� 3✓���1 INSTALLATION
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FR[DLEY
Address���� ��� ��
Name �1�E� ���.,"�11Z�C�
Date 10�'��j- ��
Old Meter Number � t ��
O!d Meter Readin ��7 �
Replacement Na �+�"�'1.
Replacement Reading �
Replacement Make 'J1��7�
ERT# ��J� ����
Replacement ERT#
Remarks:
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' City of Fridley
Water Department
6431 University Avenue NE
Fridley, MN 55432
(763)572-3566
��We hereby authorize the City of Fridley and/or its
employees to do what is necessary to replace the water meter. I understand that the property owner
is liable for the water line from the main to the premise and all interior plumbing. (Per City code
40Z.06) 1 also hold the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to include,but not limited to;valves,piping,walls,floars or the curb
stop box and service line. I understand 1 am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � ������
Name: Address:_��t1�� `—�`"
Phone Number: Date: "�'J�� •
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Signature:
. Witness Signature:
FRIDLEY CITY CODE
CHAPTER 40Z.WATER,STORM WATER,AND SANtTARY 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 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 shall pay a permit fee as provided in Chapter il of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shall be unlawful to cover any connecting 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.
4U2.86. REPAIRS AND MAINTENANCE TO CQNNECTION
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 all 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 st�eet repairs,at a rate set annually by dn 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)