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unroF AUTOMATIC METER READER
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Address�j,"��\ ��„�i�1
Name 1•�.,�����-�P I�
Date 5-�-��
Old Meter Number 9 � �
Old Meter Reading q� 'b��
Repiacement No. ��0�
Replacement Reading So
Replacement Make �P�-�L-
ERT# ��c�� C�� ��. �
Repfacement ERT#
Remarks
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` City of Fridley
Water Department
6431 University Avenue NE
Fridley,MN 55432
(763)572-3566
���e hereby authorize the City of Fridley and/or its
emplayees to do what is necessary to replace the water meter. I understand that the property owner
is liable for the water line from the main ta the premise and all interior plumbing. (Per City code
4�2.06) I etso hold the City of Fridley and/its employees harmless fior any damages that may occur
while doing this operation. This to include,but not iimited to;valves,piping,walfs,f{onrs or the curb
stop 6ox and service line. 1 understand I am also required to obtain a pecmit pria�to any work,if
necessary.
Final meter readin old meter) �--�� � '"'�
g�
Name: Address: � . ) '"�L���'�
Phone Numh r: Date: ""1 ��� �� •
Signature:
_ Witness S+gnature:
FRIDLEY UTY CODE
CHAP7ER 40Z.WATER,STQRM WATER,AND SANITARY 5EWER
ApMI1NISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191)
402,Q5.PERMlT FEE
Prior to constructing or repair of any water or sewer fine connecting the existing municipal system and any house
or building for which the application is made,the owner or contractor sha11 be required to obtain a permitfor such
� connection,and shalf pay a permit fee as provided in Chapter 110#this Code. After such connection has been
made,the Water and Sewer Department shall be notified. It shall be unlawFul to cover any connecting line until an
inspection has 6een made and such connection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.46. 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 shall be liable for atl repairs required to any water line and sewer tines
necessary for connection of the premises from the main to the premises. tf the property awner requests
maintenance service or repairs be perFormed by the City,the property owner shall 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 or use�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 638,1156,1191j