HomeMy WebLinkAboutHYDRANT PERMIT - 20-00968 - Rexburg Parks Department FHM #28FIRE HYDRANT USE PERMIT
Of
NONTRADITIONAL WATER CUSTOMERS r / r r (1p
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35Nc,rthlstf+rif Noah. Phe lheon,grexbur or v REXBURG'
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081440 ww9. ® hone: 208.372-2136
w.rexburg.org Fox 877.3973917 : ''"""';w""�1'�'�'"'K'
Meter # 2 Hose Number.- 13
date Issued !� a3�`_
Permit # 20
Business name: // �fkt u/
��X Ut--i r�
Phone #
Picked up by % iJ
Phone #
Address
Year Issued: _ gooz,
Deposit amt: (Receipt Code= WDEE) with credit cards charge an additional 3.50 (Receipt Code= MiSCG)
$1,800 - 2" Water Meter ►/ _ Deposit retained? ✓?
or refunded.
$ 800 - 1" Water Meter -
--
CONDITIONS OF PERMIT: (date)
In order to prevent possible contamination from backflow of the Rexburg city water system, any persons or enthY
desiring to obtain water from a city fire hydrant must comply with the following:
I. Obtain a written permit from Rexburg City Hall, 35 N i" 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 we hydrant
agreed upon by the user and the city water deptment.de"+"'
4. As indicated above a deposit will be required on any metering device. Any damage to or toss ota once of tam
will be paid for by the user. After any use, repair, or replacement charges are deducted ,t"e n
deposit will be refunded to the user. (City water deptwill conduct a final inspection 1
5. The fee for any water obtained through the metering device is as follows= to
gallons thereafter l b 0 assessed each year
Fee: 1 — 1,000 gallons $10.00 Each 1,OOQ g e day pet
be reissued t"e saM
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2
maintenance on the meter.A meter can
adit�taT`
7. The meter needs to be returned by 12/1 for testing calibrations,
charge 04 $400,Lo a
request if needed.
in with this policy shall
Any person or entity not comply g
to the normal charge for the water taken
REFUND TO:OUT READ �j
METER OK: YES
___ _._--- I N READ
NO ----
GAL. USED ---
READ DATE
SSUE� �
METER RE -
Issued by.
YES / Na
be assessed a peva"
CHARGESMAINT
METER
0-
1000 GAL
ADDITIONAL W
REPAIRS -PARTS
TQT AL
Recelved by