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City of Fridley _
Water Department
6431 University Avenue NE
Fridley MN 55432
(763) 572-3561
Uwe �F�1� �-�-��� hereby authorize the City of Fridley a.nd/or its
employees to do wha.t is necessary to shut off the water at the curb stop box. I understand
that the property owner is liable for the water line from the mai.n:to the premise. (Per
City code 402.06) I also hold the City of Fridley and/or its employees harmless for any
damages that may occur while doing this operation. This to inciude,but not limited to,
sod, yard,landscaping,trees,shrubs, driveways, sidewalks or the curb stop box and
service line. I understand I am also required to obtai.n a permit prior to any work.
,r � / ,
Name: (�' '� ��� �� �� .,.,..�` Address: �/.�.j /'7c/�,'r1��y' �� f!/�
c�-
Phone Number: �� '7 � � JYl���Date: � �� ��
Signature:
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Wilness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADNIINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988, 1144,115b,1191)
402.05. PEItMTI'FEE
Prior to consiructing 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 shall be required to obtam a
permit for such connection,and sha11 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 unlawfiil to cover
any connecting line until an inspection has been made and such connection an.d the work incident thereto
has been approved by the City as a proper and saitabie connection.
402.06. REPAIRS AND MAIl�iTENANCE TO CONNECTIUN
A$er 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 propexty line for co�ection,the
applicant,owner,or the occupant or user of such premises shall be liable for all repairs required to any
water li.ne and any sewer lines necessazy for connection of the premises from the main to the premises. If
the property owner requests maintenance services or repairs be performed by tt�e 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 administra.tive policy. It shall be the responsibility of the applicant,owner,occupant '
or user to'perform standard maintenance of the sewer service line fram the premises to the main including
debris clearing or raot cutting and to mainiain 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