HomeMy WebLinkAboutHYDRANT PERMIT - 19-00570 - Hill & Son Excavating, FHM#22FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35NorthlstEost Nooh.phetheonQrexburg,org Phone: 208.372-2136
Rexburg, 10,83410 www.rexburg.org Fox: 877.397.3917
Date
Business name:
Picked up by _
Address: 114
Meter # F—)YJAIuz7 Hose:
Phone #
Phone #
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CITY OF
REEXBURG
Amerin 4 Amilly Cwenuu�iry
Year Issued:
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 110 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 depositwill be required on any metering device. Any damage to or loss of the device
will be paid for bythe 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
to the normal charge for the water taken.
REFUND TO:
shall be assessed a penalty charge of $400 in addition
METER OK: YES OUT READ 270.,: CHARGES:
NO IN READ METER MAINT 75.00
GAL, USED 0-10DO GAL 10.00
READ DATE ADDITIONAL WATER
AVIETERRE-ISSUED? YES/NO REPAIRS -PARTS
TOTAL
Issued by: Received by: