Meter Swap � ���� I STALLAT ON��
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u.�� AUTOMATIC METER READER
FRtDLEY
Address �'+,�� 1' �t��
Name_.����.`l �C /L�AL�C��?��' _
Date �� -��--1�
Old Meter Number � a
Old Meter Reading � �t -
Replacement No. � � �
Replacement Reading �
Replacement Make ����,� _
ERT# .�� �Z�� V
Replacement ERT#
Remarks:
-���Signed:
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City of Fridley
Water Department
6431 University Avenue N�
Fridley, MN 55432
(763)572-3566
I/we hereby authorize the City of Fridley and/or its
employees to do what is necessary to replace the water meter. 1 understand that the property awner
is liable for the water line fram the main to the premise and all interior plumbing. (Per City code
40Z.06) 1 a(so hold the City of F�idley and/its employees harmless for any damages that may occur
while doing this operation. This to include,but nat limited to;valves,piping,walls,flaars or the curb
� stop box and service line. I understand I am also required to obtain a permit prior to any work,if
necessary. �� � � � �
/�
Final meter reading(old meter) C
Name: Address: `����`��'�
D e: ���
Phone Number: —r" '
� Signature: �
. Witness Signature: •
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANtTARY SEWER
ADMIINISTRATION
(Ref Ord No 113,464,565,566,629,638, 662,922,988,1144r 5156,1191)
,�
402A5. PERMIT FEE
Prior to constructing or repair of any water or sewer line connectingthe existing municipal system and any house
or building for which the application is made,the owner or contra�tor shall be required taa�tain a permit for such
cv�u�@E�I@�li and shafl-,�a�Ta-,^.grmit fPP a� rovid d'm Chapter 11 of this Code. After such conne�ion has been
made,the Water and Sewer Departrnent shall be notified. It shall be unlawFul to cover any conne mg�in ��'
inspection has been made and such connection and the work incident thereto has been approved by the City as a
proper and suitabte connectian.
402.06. REPAIRS AND MAINT�NANCE TO CONNECTION
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 shalt be liable for all repairs required to any v,rate�line and sewer lines
necessary for connection of the premises from the main to the premises. lf the property owner requests
mai�tenance service or repairs 6e performed by the City,the property awner shall be charged for the costs of the
mainCenance and/ar repairs, including any necessary street repairs,at a rate set annually by an administrative
poticy. It shall be the�esponsibility of the applicant,owner,occupant ar 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 se�vice curb stop box for operability and at such height as will ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)