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c�.n,oF AUTOMATIC METER READER
ERIDLEY
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Name �t��� 1����[��
Date (�`��� ��
�Id Meter Number ���q.�
Old Meter Reading � ~ ���
Replacement Na �� �� �j�
Repiacement Reading S�
Replacement Make ��.�Z._
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ReplacementERT#
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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 Frid{ey andior 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 ali interior plumbing. (Per City code
402.06). I also hold the City af Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to include,but nat limited to;valves,piping,walls,floors or the curb
� stop 6ox and service line. 1 understand 1 am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(oid meter) '��
Name: Address: 1���� �'`��
Phone Number: Date:, �`�v'� •
Signature: �
. WitnessSignature:
FRiDLEY CtTY CODE
CHAPTER 402.WATER,STORM WATER,AND SRNiTARY SEWER
� ADMIINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,488, 1144,1156, 1191)
402,05.PERMlT FEE
Prior to constructing or repair of any water ar sewer line connecting the existing municipal system and anp house
or bui{ding for which the app4ication is made,the owner or contractor sha(I be required to obtain a permit for such
conneetion,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 shali 6e 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 su'stable connecCion.
4Q2.05. REPA{RS AND MAfNTENANCE YO CONNECTlQN
After the initiaf connection has been made ta the water serviie curb stop box or the sewer lead at the property
line or a water service ar sewer lead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shalt be tiable for a1{repairs required to any wate�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 Che City,the property owner shall be charged for the costs of the
maintenance andJor repairs, including any necessary street repairs,at a rate set annually by an admiRistrative
policy. It shall be the responsibility of the appficant,owner,occupant or user to perfocro standard maintenanse of
the sewer service line firom the premises to the main including debris clearing or root cutt9ng and to maintain the
water service curb stop box for operability and at such height as wi1{ensure that it remains above the finished
g�ade of the land or property. (Ref 638,1156, 1191j