Meter Swap '� �;��a- _,`� �rt;J.7s--lt �y��-�.�
INSTALLATION
G.�� AUTOMATIC METER READER
FRIDLEY
Address �� �t S`�, ��'7'
Name � t CQ(..+� ��'�'"GS
Date � `"l�"��
Oid Meter Number r _ � `
Old Meter Reading � � "i .
Replacement No. �����1 1� �—1
Replacement Reading �
Replacement Make �
ERT# �����,1�� '
Replacement ERT#
Remarks:
4Sy'j3 Signed:
��q�t fi+�r�n�i� R�rt
Y -• C�y c�f �rMdl�
f� �s; �ll-�2- 1 ��: 12
T�e: �iF� ��i�r:
[��: Wa� �S�e: �e�ts
�� 95�M15SI��'i'I 5T 1rE _ 76�7�-�r21
�+e: 7/'1�1�'�� _
V
_ R� - +N�
�Ta�:
� �� � ���
��l�d �'1et�r#
�It� re,�ding: ����.��
��U�w �Vl��er�# �3�I�`�`�
�
��J+�v�► �#eadi�g; �
�
���� �-�-��a��3
���- ! �
�.___.__ � _�_��_���..._ e.._ , _.�__._._.__..�_.�_ ��.--------� �
,
� � �
�_�_.____ ___ .��_���_. _ __._ ____�___�
�
��: ; � � � � �� � � �� ��
� ` _`1-�C�'��•_�_�_ � �
� � City of Fridley
Water Department
6431 University Avenue NE
Fridtey, MN 55432
(763)572-3566
�'We hereby authorize the City of Fridley and/o�its
emplayees to do what is necessary to replace the water meter. 1 understand that the property owner
is tiabfe for the wateriine frum the main to the premise and all interior piumbing. (Per City code
4Q2.06� i aiso hold the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This ta include,but not timited to;vatves,piping.walls,Noars or the curb
� stop box and service line. I understand 1 am also required to obtain a permit prior ta any wurk,if
necessary.
Final meter reading(old meter) � � �� ��C`" �
Name: Address: t�� 1 "t�s' �7
Phone Number: Date:�`�~�� —
Signature:
. Witness Signature: .
. FRIDLEY CiTY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADNIINfSTRATiON
(Ref Ord No 113,464,565,566,6�9, 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 municipaf system and anq 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 11 of this Code. After such connectian has been
made,the Water and Sewer Department shall be notified. It shafl be unlawful to caver as+y cannecting line until an
inspection has been made and such connection and the wark incident thereto has been approved by the City as a
proper and suitable connection.
4U2.06. REPAIRS AND MAINT�NANCE 70 CONNECTION
After the initial connection has been made to Che water service curb stop bax or the sewer lead at the property
line or a water senrice or sewer lead has been extended to the property line for cor►nection,the appticant,owner,
or the occupant or user of such premises sha11 be liab{e for a{{repairs required to any wate�line and sewer lines
necessary far connection af the premises from the main to the premises. If the property o�t�tner requests
maintenance service or repairs be performed by the City,the property owner shatl be charged for Che costs of the
maintenance and/or repairs, incfuding any necessary street repairs;at a rate set annuat(y by an administrative
poticy. ft sha11 be the re$ponsibifity of the appticant,owner,accupant or user to perform standard maintenance of
the sewer service iine from the premises to the main includ'+ng debris clearing o�root cutting and to maintain the
water service curb sCop box for operabifity and at such height as will ensure that it remains above the finished
grade of the fand or property. (Ref 638,1156,1191J
R��es�fc�r�er�e R�:p�rt
�C��y+�f Fr�dley
#�# �a: �1-t�-�� ��: 9I�/20t2
T�e� L��er ���y:
E�r _ V1lat� .
Ad�= �5t'M1SStSS�1�T�IE �c P�: 763�71-2.'�r21
[�: 9s/�JZI�7��3t'!J�ll {�er:
�[)etai�: �ea�Elet+a�s: tiad/1i�iretaied in.��'!2
No���s ic�eng aro�nd a�ide#
�
T ' _
��
' ,,� ��..� � � �� ��`t �c�� L���
I
� — - A �t.._.u�.��2 co T'.�`�'�,
�
��� C���
�
�
���� ,
�
� ...............__........_. .._._.J
a ✓
� � `.(` i�