HomeMy WebLinkAboutHYDRANT PERMIT 2 - 19-00560 - Madison County, FHM #14Date
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North Ist East
Nooh.phethean@rexburg.org
Phone:
208.372-2136
Rexburg, ID 83440
www.rexburg.org
Fax:
877.397.3917
Meter #
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Address:
Phone #
C IT Y OF
REXBURG
America's Family Cammuntry
Hose Number:
Phone #
Year Issued: %/: d
Deposit amt: (Receipt Code= WDEP) /
$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 1'` 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 V 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.
Signature of Applicant
REFUND T0:
METER OK: YES OUT READ 526 91 CHARGES:
NO IN READ 9 a METER MAINT 75.00
GAL. USED 3, 0- 1000 GAL 10.00
READ DATE ADDITIONAL WATER
METER RE -ISSUED? / NO REPAIRS -PARTS
TOTAL
Issued by: Received by:
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