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HomeMy WebLinkAboutHYDRANT PERMIT - 19-00669 - Headwater Construction FHM #1535 North 1 st East Rexburg, ID 83440 FIRE HYDRANT USE PER NONTRADITIONAL WATER CUSTOMERS Noah.phetheananrexbvrg.org Phone: 208.372-2136 www.rexburg.org Fax: 877.397.3917 l i T Y O F REXBURG CW Nnenuu lvmitY Cnmmun"y Date Issued 10 Ise> I a Meter # J S" Hose Number: /l0 jh-oSt j Permit #�� 3S6 �� Business name:Phone#PojI coylsmIC4-io n Phone If �\Da - Picked up by Y `1av1-G ���P,f�71'L�rl.Coy� ?-7oA67!5 Address: a,5S Suefe l \/I C(nC (b is 466 Year Issued: Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG) $1,600 - 2" Water Meter Deposit retained? or refunded? $ 600 - 1" 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 151 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. is policy shall be assessed a penalty charge of $400 in addition Any person or entity not complying with th to the normal charge for the water taken. Signature of Applicant REFUND TO: METER OK: YES. OUT READ NO IN READ GAL USED U READ DATE 70 2 METER RE -ISSUED? YES/NO CHARGES: METER MAINT 0-1000 GAL ADDITIONAL WATER REPAIRS -PARTS l TbTAL . Received b Issued by:,. e -1==-4 75- 10.00 Der 41r GaD: ath era. No (✓© M iI