Loading...
HomeMy WebLinkAboutscan0039Date FIRE HYDRANT USE PERMIT NONTRADITIONAL WATER CUSTOMERS 35North1st East Nooh.phethean®rexburg.org Phone: 208.372-2136 Rexburg, ID 83"0 www.mxburg.org Fox: 877.397.3917 Meter # CITY OF REXBURG rU� AmmkaY Fm,Jly Comrwnity 10—mEtlTi, MW J Permit# Businessname:Ybl.nflam ,,,,_l'I ,,G _P Phonew�(DS/— 650 Picked up by Wl a y tl o )ea 1AA; Phone # Address: (0 Z S S_ N'1 Q 1,h , G�ea fLI e�L$ r(// Year Issued: Z©I� Deposit amt: (Receipt Code= WDEP) with cre cards charge an additional 3.5% (Receipt Code= MISCG) $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 V 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 $400 in addition to the normal charge for the water taken. /� SLC On ! In At V1 Signature of Annlicant REFUND TO: _ METEROK: YES_ OUTREAD B$QA CHARGES: NO _ IN READ k2:z;z METER MAINT 75.00 GAL. USED READ DATE METER RE -ISSUED? YES / NO Issued by: Ile 0-1000 GAL 10.00 ADDITIONAL WATER REPAIRS -PARTS TOTALo Received by: