HomeMy WebLinkAboutHYDRANT PERMIT 2 - 19-00574 - Rexburg Park Department, FHM#28Locy ,
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FIRE HYDRANT USE PERMIT
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NONTRADITIONAL WATER CUSTOMERS t1rVT;T m�
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35 North lsf East tlebo hl@rexburg.org Phone: 208.372-2347 ;,,. •�,.,, r,,.,.::. .,,,.,..,,, .
Rexburg, ID 83440 ww.rexburg.org Fax: 208.359.3022
Date Issued a I rl /
Business name:
Picked up by _
Address:
�/r'L S 74n Azrs �%
Meter #
F#11 �a g
pf. Phone# g59— 303R
Phone #
Yadp XS&z4&_d 2619
n -Deposit amt: (Receipt Code= WDgP)
Address* --
%f 226 Ad $1,600 Large Capacity Water Mete Deposit retained? or refunded?
rzzs � $ 600 Small Capacity Water Meter
( date)
Deposit amt
E0007 X1,600 Larg CONDITIONS OF PERMIT:
Nnmoc $ 600 Sm2
In order to prevent possible containation from backflow of the Rexburg city water system, any persons or
me
entity desiring to obtain water fro ' a city fire hydrant must comply with the following:
GONDI7IC 1. Obtain a written permit from exburg City Hall, 35 N 1" East, before attempting to take any water.
f 2. Take water only from the one lire hydrant designated by the city water department.
In order 3. Checkout the backflow and metering device from the city water dept. to be attached to the fire hydrant
entity d` agreed upon by the user and t e city water deptment.
1.
4. As indicated above a deposit will be required on any metering device. Any damage to or loss of the device
645 will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the
ration as 3'
deposit will be refunded to the user. (City water dept. will conduct a final inspection.)
MM 4. 5. The fee for any water obtaine through the metering device is as follows:
OWN Fee: 1 — 1,000 gallons X510.00 Each 1,000 gallons thereafter : $5.00
1per)
IPwin 6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year or
IWyy maintenance on the meter.
i per r
I Per 3Y dt Any person or entity not complying ith this policy shall be assessed a penalty charge of $400 in addition
2 per 3Y du, to the normal charge for the water t en.
Per 3Y due .
ler 3Y due b
efra be A Signature Applicant
t(
REFUND TO:
METER OK:
Joy
YES OUT REA
NO IN READ
GAL. USE
READ DAT
METER RE -IS!
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ED? )9/ NO
CHARGES:
METER MAINT.
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
75.00
10.00
/R
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