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FRIDLEY
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Name �1M�Z k1C�?��1�
Date ���` ��
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Old Meter Number , �
Old Meter Reading ��
Replacement No. . o� l� ��
Replacement Reading �
Replacement Make . f'�►�C'�Z
ERT# ���� �t'1��
Replacement ERT#
Remarks:
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- City of Fridley
Water Department
6431 UniversityAvenue NE
Fridley,MN 55432
(763)572-3566
��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 liable for the water line fram the main to the premise and all interior plumbing. (Per City code
40Z.06j I atso hold the City of Fridley and�its employees harmless for any damages that may occur
while daing this operation. This to include,but nnt limited to;valves.piping�walls,floars or the curb
� stop box and service line. {understand 1 am atsa required ta obtain a pe�mit prior to any wurk,if
necessary. �
readin old meter ��� ��
Ftnal meter g( )
Name: Address: �' ' �����2E5�
Phone Num6er: . ---'"` Date:_ �� L J�— � �
Signature:
. Witness Signature: .
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMIINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156, 1191)
402A5.PERMR FEE
Prior to cc►nstructing or repair of any water or sewer line connecting the existing municipal system and any house
or building for which the application is made,the owner or contractor shafl be required to abtain a permit for such
conneetion,and shal{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 notified. It shall be unlawful to cover any connecting line until an
inspection has heen made and such connection ar+d the work incident thereto has been approved by the Cty as a
proper and suitable connectian.
4U2.06. REPAIRS AND MAINTENANCETO 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 properry iine far connection,the applicant,owner,
or the occupant or user of such premises shall he liable for all�epairs required to any water line and sewer lines
necessary for cannection of the premises from the main to the premises. If the propetty owner requests
maintenance service or repairs be performed by the City,the property owner shall6e 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 uset'to perform standard maintenance of
the sewer service line from the premises to the main including debris clearing ar root cutting and to maintain the
water service curb stop box for operabi4fty and at such height as will ensure that it remains above the finished
grade�f the land or property. (Ref 638,1156,1191) .
Request Number: 10527
Public Works Division
Service Request
Problem Address: 6360 Van Buren St Requested$y: Sandi Hara
Department: WATER Adddress: No address provided
Problem/Issue: FINAL METER READING Phone Number:
Schedul ed Date: SchedW ed'If ine:
AC'I�ON NEEDED:Final reading.Closi 9/21/1 ERT#33370832
Created by: Wendy Hiatt Date Created: 2015-09-14
ACTION TAI�N:
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Status: in Progress Resident Contacted ❑
Date Completed: Completed by:
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