HomeMy WebLinkAboutHYDRANT PERMIT 2 - 19-00562 - HEADWATERS CONSTRUCTION, FHM #19rarPrj
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107Z No
35 North 1 st East
Rexburg, ID 83440
FIRE HYDRANT USE PERMIT ,<�°•^ R�:,,
NONTRADITIONAL WATER CUSTOMERS
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Nooh.phethean®rexburg.org Phone: 208.372-2136
w .rexburg.org Fax: 877.397.3917
Date Issued Y/191 .�te/ I Meter # JC#J41 4'� /`% Hose:
CITY OF
RMURG
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Amerlcak Pauly CQmiry
Business name:
Le.a/_ N rnv( V4cc4r� Phone # ot3 - 757-
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Picked up by �G(ss�� / ul t �c .A Phone #
to the normal
Address:
for
the water take%
/1�'ar� Year Issued:
Deposit amt: (Receipt Code= WDEP)
$1,600 Large Capacity Water Meter Deposit retained? or refunded?
$ 600 Small Capacity Water Meter _�
( date)
CONDITIONS OF PERMIT:
In order to prevent possible contamination from backflow of the Rexburg city water system, any
persons or entity
desiring to obtain water from a city fire hydrant must comply with the following:
1. Obtain a written permit from Rexburg City Hall, 35 N 1" East, before attempting to take any water.
2. Take water only from the one fire hydrant designated by the city water department.
3. Check out the backflow and metering device from the city water dept. to be attached to
the fire hydrant
agreed upon by the user and the city water deptment.
4. As indicated above a deposit will be required on any metering device. Any damage to or
loss of the device
will be paid for by the user. After any use, repair, or replacement charges are deducted
,the balance of the
deposit will be refunded to the user. (City water dept. will conduct a final inspection.)
5. The fee for any water obtained through the metering device is as follows:
Fee: 1-1,000 gallons $10.00 Each 1,000 gallons thereafter : $5.00
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each
year for
maintenance on the meter.
7. The meter needs to be returned by 12/1 for testing calibrations. A meter can be reissued the same day per
request if needed.
Any person or
entity
not
complying with this policy shall be assessed a penalty charge of $400 in addition
to the normal
charge
for
the water take%
REFUND TO: _
METER OK: YES
NO
Issued 0y
OUT READ _
IN READ 731
GAL. USED
READ DATE _
METER RE -ISSUED?
eiz�
YES/ NO
icant
CHARGES:
METER MAINT 75.00
0-1000 GAL 10.00
ADDITIONAL WATER
REPAIRS -PARTS
TO
Received by:
V V
Rexburg.
I L year of the hire date
in 3 months of hire.
surg, at rexburg.orsc For
2019 at 11:59 PM