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Meter Swap Y7 � ��<�-�"�� INSTAL TION ��� ' cin�oF AUTOMATIC METER READER FRIDLEY Address t��'L)�� ��-��� _ Name cl ��C,7'�������"� Date ���—�o�. Old Meter Number ��' � � (� Old Meter Reading ` - ` Replacement Na [�tD l Replacement Reading ,� Replacement Make ��. ERT# ��� �C��� � Replacement ERT# Remarks �?�{7 Signed� R�qt��� fnr SSenric� Ft�rt r � C�#y t�f Frici{� i� t'�!€r: �t-�2-4802 D�e: �tt�12 T�e� �IIiR� E3�r: I$+e��� WI(a� �tiz��: .#��ea�t ll�dr�ss= 6�1�i �T� . �►12-�7�fi8 Sd�d tl�+�= 5J�A1�"8�itt#�i��� , �+(3w�er: 6rt��19-?879 . �t Ueta�: /li� A�n Ta�= �I�i �le��er# ��� C�{�� �id r�adir��� `�J�j1 ��� Nev�r ���er# �(�� �`��� �J�:w �e�ciing: � , ��-�� 3�3� tioap t a � � � ; � _ �___m___ _____ _______� ___ _____________�_� ��� � � ��_������..���.� _._�...._e.__..�.�.-- _-�_ I v ; i �..........._w_m__._ �........______...._....__�._.............__.._..._ �......_ _._._.v_____..�......_._............_ � i _ � ��_ i � � � �.`�� __� '� _ v� - City of Fridley Water Department 6431 University Avenue NE Fridley,MN 55432 (763)572-3566 �/we hereby authorize the City�f Fridfey and/or its employees to do what is necessary to rep{ace the water meter. I understand that the property owner is(iable for the water line from the main ta the premise aad aif interior plumbing. (Per City code 402.06) t also hold the City of Fridley and(its employees harmiess 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 box and service line. I understand I am also required to abtain a permit prior ta any work,if necessary. finai meter reading(ofd meter) � �� � �� Name: Address: 1['9��� � �-�N - Phone Number: Date: �'��—`� Signature: � . Wltness Signature: FRIDLEY CITY CODE CHAPTER 402.WATER,STORM WATER,AND SANfTARY SEWER ADMiNISTRATtON (Ref Ord No 113,464,565.566,629,638,662,922,488,1144,1156, 1191� 402.05. PERMIT FEE Prior#o constructing or repair of any water or sewer line connecting the existing municipal system and anq house or buitding for which the application is made,the owner or contra+ctor shafl be required to obtain a permit for such connection,and shaii pay a permit fee as provided in Chapter li 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 until an inspection has been made and such connection and the work incident thereto has been approved by the City as a proper and suitable connection. 402.05. REPAIRS AND MAIN7ENANCE TO CONNEC'f10N 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 connectlon of the premises from the main to the premises. If the property owner requests maintenance service oc sepairs be perfarmed by the City,the property owaer shal!he charged for the costs of the maintenance and/or repairs, including 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 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 operabiliry and at such height as wiil ensure that it remains above the finished grade of the{and or property. (Ref 638,1156,1191) Req�t fvr S�rvi�e R+�part City af Fridley Ref�e�: �-12-51� �-at�: 7r2S,r�{112 F�equest T�rpe: 5mk hde ��ed E3y: W�+dy Hi�t t3epartm�t: Sewer C�z�N�ne: ,k>e �� �10,lA�CKSt�M ST NE a€�c Ph�e: 61'2-2��-8�8 �CFr�duted Date_ Prnperiy(h�ner: Location[��s: Fi�iest Uetadx_ CF�eck sinicbole in fmrt yard appranc_ 1 fod b�d cxnb_ Acti�T�: � � �. ���� c�.�f v�ir� (�\�t�1�C�- ,� a�� �� E� , . � . � �_ � �� �5�.�r�� St�(t[(C�- �� Ll �D� �L�►� � I�V � 1 � , , , � < <ti�� �,�-��S IA�� tS�- ��U'` � -5�r�c t« f r� �' � , � , � �.<< ��.. . � ; � ; � , � � � � �,���: ` , � '�.��� _ _ ___ ! �,��: ,; ! �����' __ _ � �����. ; ��� 1 a� _ '�a�-L— _ ; �i,� G��c.�� ���-� R�q�� tor �enr�e Rep�rf �r �� `���� �rty c�f Fr�d�y � ��r�: �-�2-�ia7 0���: �,Fza,�o�� � T,�: Tv��u� r��a,�: �v��c ���: � �a���: � Adiineas� s310,1ACICSON ST ME ac:�s Pt�cme: 612-�7-�8 Sc�d►ft�d Qate� 8J1�12 it?:Ot}IAA1 Pmpe.rty Oa�er: h�rx�ay ����,���: _.J � �c�= �rw►�s� �,T��: �.l � 1 \ �`�<=-����sp.�� �'�b��`�\ ,`_`��Gf\ � <o^;�- \�, �-�. �o'.n� r�� ..� -�,,� , � �, .� �� ��r . : �I � , , '�a ��� �-��h� �6_�\O•�r. ��'����Cc� �rie.C�� � C7���-�c�.�. �j�` �i ���Z � \ ` � , ���``�-1 �'�r'`�'�,�C��, r.� �j��� 1 `(��J�� �R �Alcj��.� C,�y,..:�� \���� � Co`'.�c� ��� i \�� � � S�`�`' �'e`�r��.e�r_ ��`:��Y�.� ` � V c�� d�C'`� � \��@ c � �p� I _� _� 1\J �) r VVV'� [ �� ; ���.� �� , ,� " '� �-�-f� �� �i3c�� �1�` `�oa�� ; Sy��� �,r � ' ' �', ;�� � ��, ' ���� �,, � _y , . ., t >, � �,.L�_,c'�� �( ,'�C�'y �Q c'�,�L 1�'G � '���� � ; �.���� n��C'F.�� i ( _ � � . 1 � ` ,� % \ (� � , F �'�_ ,` \�.� �:15'�i% V:\1 � c}c�.� ,� _ \ /:-•�\cC'C \\ ���-`� \! �`- `:l� _. __� .� �.. �'iSIF�I�P�fStN7: ( _ a � . ,� � . ��J \� k-� . � ,4iK "�= 'C� . .. - -�� -=. __. m.. ...: i ��: 3 �D�e: �i1 -\ ,� � �z+�(dotfied r��•./�o; �t c�L����� ` .., , _ _ .�1� .� ��._ ��_� � � ' � : t � �� � � ,� � � � � �� � ; � ., � � � � � � .. � � .. � �. , ��� ��. ; .� � . . � 3- � � .� �� � � � � k� � � � � � �� � N � � ? � � �� ' � � i � � � �` � � ; � j � �� i � � ; � �� � � � ; � � �° � � � # � .� , � � �� � � i � � � �, � � � � � � ; i � ' ,�` "`' . � � � � � � ' � � � ' C� , i ; -+, 1 � � �,� � ""I'1 3 � � ` ` ' �� ! � � � X � � � .. � � �� � � �. � � 3 � �'�, [ . � .> i � � � � � �� � �� � � � � � �' � � � � � � �' � � N � � � � �� �' �� � � �� � � . � �� � �� ���t f�'� _ R+�p►a�rt Gi�y c�f Fridl�t �: �-�2-���s ���: ��0�2 T�� s�r� �� €�c �,c: � c��� .� na�: +�» s�r� . s��-z�-asss ��: �c�: �c�� � �= ����.�c��- y��a�: ���_ �� � � �_ ww����-�r� _ ���€��� _ � ;� _ � ; �_._.._—_ ---------__._..... . � �� [. _�__� ___�__._. _� _�� ____ � ��� ��rz�rzQ��z�n� �� � � � �_� �art . .m_m.. . �rt� �____�,