Meter Swap '� �'��-_:a-�- `�.����S r�t �j5��7�
INSTALLATION
�� AUTOM TIC METER READER
FRIDLEX '
Address � �1.;' � `
Name ���'��..� ��
Date�`����
Old Meter Number ���
OId Meter Reading � �� �
Replacement No. t.'l�"� r� ��
Replacement Reading �
Repiacement Make ���
ERT# �,��� �� �7� �,/
Replacement ERT#
Remarks:
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City of Fridley
Water Department
6431 University Avenus NE
Fridley,MN 55432
(763)572-3566
IJwe hereby authorize the City of Fridley andjor its
employees to do what is necessary to replace the water meter. 1 understand that the property owner
is tiabfe for the water line from the main to the premise and ali interior piumbing. (Per City code
4d2.06) I afso hotd the City of Fridtey and/its employees harmtess for any damages tfiat may accur
whi{e doing this operation. Tfiis to include,but not timited to;valves,piping,waNs,floors ar the curb
stop bax and service line. I understand f am also required to obtain a permit priar ta any wark,if
necessary.
Fina!meter reading{old meter) � `�✓�� � � `�-'
Name: Address: `��t� ""''�
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Phone Number, Date: �G,�� �
Signature:
. Witness Signature:
FRtQLEY CITY COQE
CHAPTER 402.WATER,STORM WATER,ANU SANtTARY SEWER
ADMINtSTRATION
(Ref Ord No 113,464,565,5b6,629,638,662,922,488, 1144t 1156, 1191J
402.05.PERMIT FEE
Prior to constructing or repair of any water or sewer fine connecting the existing municipa{system and any house
or 6uildi�g for which the application is made,the owner or contractor shaA 6e required ta obtain a permit for such
connection,and shall pay a permit fee as provided in Chapter il of this Code. After such connection has been
made,the Water and Sewer Department shali be noti�ed. it shafl be unlawfuf to cover any connecting fine until an
inspection has been made and such connection and the work incident thereta has been approved by the City as a
praper and suitable connection.
402.06. REPAIRS AND MAiNTENANCE TO CONNECTION
After the initial connection has been made ta 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{ine for cannection,the app�icant,owner,
or the occupant or user of such premises shall6e liable for all repairs requi�ed to any water line and sewer lines
necessary for connection of the prernises from the main to the premises. If the property owner 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 annual4y by an adr►�inistrative
policy. lt shal4 be the respansibility of the applicant,owner,flccupant ar user to perform standard maintenance af
the sewer service line from the premises ta the main inc(uding debris clearing or�oot 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)
F���t f+�r� , �'
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Tj�pe= €ltErer�iirat�Dept_� E3�r: Y�lendy Fi�t
�t: Wat� t�n�e: €:�C Hayes
Add�� �+i0 Mflt�E l.A��t W . �[;3-�i7�-3727
Scfr��e:d fl�= �r t�ra�
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Ae�n T�en:
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