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Old Meter Number �'-1�I oC�
Old MeterReading ��
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Replacement Reading �
Replacement Make
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Replacement ERT#
Remarks
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- City of Fridfey
Water Department
6431 University Avenue NE
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. I understand that the property owner
is liabie for the water line from the main to the premise and atl interior plumbing. �Per City code
40Z.05) i a(so hold the City af Fridley andiits employees harm{ess for any damages that may occur
whi{e doing tfiis vperation. 7his to include,6ut not limited to;va{ves,piping,wa{Is,fioors ar the curb
� stop box and service line. 1 understand I am also required to obtain a permit prior to any work,if
necessary.
Finaf ineter reading(old meter) ��� ��
tYame•_�-�='�'� �� Address: � ��� ����
Phone Number. Date: �� ��
Signature:
. Witness Signature:
FRIDLEY CtTY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,6�9,638,662,922,988,1144, 1156, 1191)
4Q2.05.PERMIT FEE
Prior to constructing or repair of any water or sewer line connecting the existing municipal system and any house
or building for which the appiication is made,the owner or contractor shafl be required ta obtain a permit for such
connection,and shalt pay a permit fee as provided in Chapter 11 of this Code. After such connection has been
made,the Water and Sewer Department shall be natified. It shai{be unfaurfu{to cover any connecting line unti4 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 MAfNTENANCE TD 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 iead has been extended to the property line for connection,the applicant,owner,
or the occupanC or user of such premises shall be liable for all�epairs required to any water iine and sewer iines
necessary for connection of the premises from the main to the premises. if the property owner requests
maintenance service or repairs be performed by the City,the property awner shali be charged for the costs of the
maintenance and/or repairs, including any necessary street repairs,at a rate set annually by an administrative
policy. It shall be the responsibility 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 service 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)
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Request Number: 10220
Public Works Division
Service Request
Problem Address: 6300 Quincy St Requested By: Carol Riske
Department: WATER Address: No address provided
Problem/Issue: OTf�R Phone Number: 571-2290
Scheduled Date: 2015-06-23 5cheduled Time: 01:00:00
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ACTION NEEDED:Water has air bubbles.Please check
Created by: - Wendy Hiatt Date Created: 2015-06-23
ACTION TAI�N:
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Status: In Progress Resident Contacted p
Date Completed: Completed by:
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