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�� L���'��� INSTALLATION
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Name �LM 1���� I��}1�
Date �(`''����/'��
Oid Meter Number � � � 'J�J
Old Meter Reading
Replacement No. �o « � !1
Replacement Reading �
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Replacement Make
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Replacement ERT#
Remarks:
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, ` ^ City of Fridley
, f Water Department
fi431 University Avenue NE
Fridtey, MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley and/ar its
employees to do what is necessary to replace the water meter. 1 understand that the property owner
is liable for the water line fram the main to the premise and all interior plumbing. (Per City code
40Z.06j 1 alsQ hold the City of Fridley and/its employees harmless for any damages that may occur
wFrile doing this operation. 7his to inciude,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 to any work,if ;
necessary.
Final meter reading(old me�ter)
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Name: Address:_
Phone Number. Date: I ����—t�l� •
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• Signature: ���
. Witness Sign ure: . :
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord Na 113,464,565,566,6�9, 638, 662,422,988,1144,5156,1191}
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer line connectingthe existing rsiunicSpat system and any house
or buifding for which the application is made,the owner or contractor shall be requi�ed to obtain a permit for such
se�nes�a�n,an�shal{=Pa�T��ermit fPP as Rrovided in Chapter il of this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shafl be unlawful to cover any conne ing�n "'
inspection has heen made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
�
4d2.06. REPAIRS AND MAINT�NANCE TO CONNECTION
After the initla[connection has been made to the water service curb stop box or the sewer{ead at the property
line or a water service or sewer lead has been extended to the propertV fine for connection,the applicant,owner,
or the occupant or user of such premises shaii be liable for a�l repairs required ta any v,rater line and sewer lines
�ecessary for connection of the premises from the main to the premises, lf the property owner requests
maintenance service or repairs be performed by the City,the property owner shall he charged for the costs of the
mainCenance and/or repairs, including any necessary street repairs,at a rate set annual(y by an administrative
policy. !t shall be the responsibility of the appticant,owner,occupant ar user to perform standard maintenance of
the sewer se�vice line from the premises to the main including debris clearing or root cutting and to maintain the
water service curb stop box far operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191y