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City of Fridley
Water Department
6431 University A�enue 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 liable for the water line from the main to the premise and all interior plumbing. (Per C�ty code
402.06) 1 also hcld the City of Fridley and/its employees harmless for any damages that may occur
while doing this operation. This to inciude,but nat iimited to;valves,piping,walts,floors or the curb
' stop box and service line. I understand I am also required to obtain a permit prior to any work,if
necessary.
Final meter reading(old meter) � l ��v - _
Name: Address: ��� ����''"'�� �
Phone lVumb : Date: �� ��('�_
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Signature: �
Witness Signature:
FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER,AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156, 1141)
402.05. PERMIT FEE
Prior to constructing or repair of any water or sewer(ine connecting the existing municipal system and any house
or building fo�which the application is made,the owner or contractor shall be required to obtain a permit for such
connection,and shall pay a permit fee as provided in Chapte�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 and the work incident thereto has been approved by the City as a
proper and suitabie connection.
402.06. REPAIRS AND MAINTENANCE 7'O CONNECTION
After the initiel connectian has been made to the water service curb stop box or the sewer lead at the property
line or a water service or sewe�lead has been extended to the property line for connection,the applicant,owner,
or the occupant or user of such premises shali be liable for all repairs required to any water line and sewer lines
necessary for connection of the premises from the main to the premises. lf the property owner requests -
maintenance service ar repairs be performed by the City,the property owne�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,awner,occupant or 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 operabitity and at such height as wiil ensure that it remains above the finished
grade of the land or property. (Ref 638,1156, 1191)
/
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