HomeMy WebLinkAboutHYDRANT PERMIT - 19-00492 - Track Utilities, FHM#2Monty."yMi4iry .nyV���u'"'rny ( ext
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35 North Ist East
Rexburg. ID 83440
Date
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FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Nooh.phethean®rexburg.org Phone: 208.372-2136
www.rexburg.org Fax: 877.397.3917
Meter #
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Address: Q111 C.' C 'kPt'.k'4j-li &K
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Deposit retained? or refunded? (d te)
Deposit amt: (Receipt Code= WDEP)LJ
$1,600 Large Capacity Water Meter
< hnn Small Caoacity Water Meter
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Phone #
Phone # 7 V AA (Pr --A4'
Year Issued: Z V 1
CONDITIONS OF PERMIT: y y persons or entity
In order to prevent possible contamination from backflow of the Rexburg cit waters stem, any
desiring to obtain water from a city fire hydrant must comply with the following: water.
1. obtain a written permit from Rexburg City Hall, 35 N is' East, before attempting to take any
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.
ned by 12/1 for testing calibrations. A meter can be reissued the same ay per
7. The meter needs to be retur
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 tafk�,i"'1'�� 1
REFUNDTO: j CHARGES:
METER OK: 5 "5 OUT READ .
NO IN READ y �� METER MAINT
GAL. USED L,1,9210 0-1000 GAL
READ DATE ADDITIONAL WATER
METER RE -ISSUED? )P/ ft REPAIRS -PARTS
TOTAL
Received by:
Issued by: ev
or
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10.00