HomeMy WebLinkAboutHYDRANT PERMIT - 19-00576 - Fire Department, FHM#33P rdp '�L
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FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North lst East de'
borI^rexburg.org Phone: 208.372.2347
Rexburg, ID 83440 ww.rexourg.org Fax: 208.359.3022
' Date Issued s
Business name:
Picked up by _
Address:
FI
Deposit amt: (Receipt Code= WDEI
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$1,600 Large Capacity Water Meter
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$ 600 Small Capacity Water Meter
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CONDITIONS OF PERMIT:
In order to prevent possible contam
entity desiring to obtain water from
1. Obtain a written permit from Ri
2. Take water only from the one fi
3. Checkout the backflow and me
agreed upon by the user and th
4. As indicated above a deposit wi
will be paid for by the user. Aft
deposit will be refunded to the
S. The fee for any water obtained
Fee: 1 — 1,000 gallons
6. A $50.00 maintenance fee for
maintenance on the meter.
Any person or entity not complying
to the normal charge for the water ti
REFUND TO:
METER OK:
2ssued joy
YES OUT REA[
NO IN READ
GAL. USEC
READ DATE
METER RE-ISSI
DEQ Public Drinking Water System
Monitoring Schedule Report
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Meter # r C. � 1!��/�/F 5 _i/tL�S/' u�sC•l /
aLnvl' Phone #
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ve__ Deposit retained? or refunded?
( date)
Iation from backflow of the Rexburg city water system, any persons or
city fire hydrant must comply with the following:
(burg City Hall, 35 N 1" East, before attempting to take any water.
hydrant designated by the city water department.
!ring device from the city water dept. to be attached to the fire hydrant
city water deptment.
be required on any metering device. Any damage to or loss of the device
any use, repair, or replacement charges are deducted ,the balance of the
(er. (City water dept. will conduct a final inspection.)
rough the metering device is as follows:
0.00 Each 1,000 gallons thereafter : $5.00
and $75.00 maintenance fee for 2" will be assessed each year for
this policy shall be assessed a penalty charge of $400 in addition
Signature of Ap$licant
ED? YES/ NO
CHARGES:
METER MAINT,
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
_75.00
10.00
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