Meter Swap 6/11/12 � ,`. '' r ` ,
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'� `�''` INSTALLATION
��,. AUTOMATIC METER READER
FRtDLEY
Address �l.J�,.J t�5� J"�'
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Name (-o l� l t t_.�.'gj��2��
Date �`�� `�-
Old Meter Number � y U
Oid Meter Reading �
Replacement Na �� ' ��i
Repiacement Reading �
Replacement Make
ERT# ���� �� �� ��
Replacement ERT#
Remarks
�,� Signed:
s ' F��eques� f��er� R
�iiy c�f Frid�
t� �: s��-�z-�� ��: �z�ezo�2
T�= � Q�'� �r:
� Y1�a�er fiam�en�+e: Tct�r�
Add�� 7�1�ItS,SISSI�"PI ST NE . 763-�71-7�69
il�ate: 6f 11lZL31�IA�A��IAM � �uP . - �612-71G�-S8�
Requ�t Qeta�s= Ai�
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- City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)5723566
I/we hereby authorize the City of Fridley and/or its
employees ta do what is necessary to reptace the water meter. I understand tfiat the property owner
is liable for the water line from the main to the premise and all interior pluml�ing. tPer City code ,
402.06i i also h41d the City af Fridley and/its employees harmless for any damages that may occur
whi{e doing this operation. This to incfude,but not timited to;vaives,piping,wafls,flonrs or the curb
� stop box and senrice line. i understand I am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) ��� ��O
Name: Address: �IJI.J !"`�S�t S7
Phone Number:
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Signature:
. WitnessSignature:
FRiDLEY CITY CODE
CHAPTER 402.WA7ER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,5156, 1191)
402.05.RERMIT FEE
Prior tv constructing or repair of any water or sewer line connecting the existing municipal system and any house
or 6uildi�g for which the application is made,the owner or contractor shall 6e requi�ed ta obtain a permit for such
connection,and shall pay a permit fee as pravided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be noti�ed. It shafl be uniawfui to cover any connecting Ilne 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.
402.06. REPAIRS AND MAiN7ENANCE TO CONNECTION
After the initial connectian has been made to the water service curb stop box or the sewe�lead at the property
fine or a water service or sewer lead has been extended to the property line for connection,the applicant,owner,
or the occupant ar 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 ma+n to the premises. !f the property owner requests
rnaintenance service or repairs be performed by the City,the praperty owner shall be charged far the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annuaily by an administrative
policy. It shall be the responsibility of the applicant,owner,occupant or user to perForm standard maintenance of
the sewer se�vice line from the premises ta the main including debris clearing or coot cutting and to maintain the
water service curb stop box for operabifity and at such height as wiN ensure that it remains above the finisfied
grade of the land or property. (Ref 638,1156, 1191�