HomeMy WebLinkAboutFIRE HYDRANT PERMIT - 20-00479 - Black Pine Directional Inc #29_`gt
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CAD~ BY.
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Proper Air Gap; NC
General comments;
rr
Check Seals & Gaskets: No
Clean Float:
Did you rePlace an No
Y gaskets/sealsT:
No
35 North Ist Eost
Rexburg, ID 83440
Date Issued(
Business nam V
Picked up by
Address: U00
FIRE HYDRANT USE PERMIT y�<�°`°°° I T Y 0
1�
NONTRADITIONAL WATER CUSTOMERS o 0 XB mG
Nooh.phetheon@rexburg.org Phone: 208.372-2136 Amer(.aihimQy(*)mmumo.
www.rexburg.org Fox: 877.397.3917
2D Meter # 2Q Hose Number:_
t .e vt Phone #
t� Phone #
4, (C�
C7/ Lk Year Issued: 2_`'z,-)
Deposit amt: (Receipt Code= WlD P) with credit cards charge an additional 3.5% (Recei t Code= MISCG)
$1,800 - 2" Water Meter I/ Deposit retained? or refunded? (date)
$ 800 - 1" Water Meter
CONDITIONS OF PERMIT: g persons or entity
In order to prevent possible contamination from backflow of the Rexbur city water system, any
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 1s` 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.
ting calibrations. A meter can be reissued the same day per
7. The meter needs to be returned by 12/1 for tes
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 wt!taken. 1
REFUND TO:
METER OK:
Issued by:
YES
NO
OUT READ
IN READ
GAL. USED
of Applicant
READ DATE
METER RE -ISSUED? YES/ NO
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Received by:
75.00
10.00