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HomeMy WebLinkAboutHYDRANT PERMIT 2 - 19-00755 - Headwaters Construction - FHM#32a� 4evo �eOA, )J datPe`�tavolq ae�eed pettacv. a% C30 ` SS o�c \ Qad (\E�atn 0 Jew�\ OW 401 OZ0 SG�1e* 0 aetsot� ad 1-1600 g OW , P�pNe\Q q\e �`ac-�ogot�at`o�oo re S t to Ex�d FIRE HYDRANT USE PERMIT NONTRADITIONAL WATER CUSTOMERS 35 North IstEast Nooh.phetheon ®rexburg.org Phone: 208.372-2136 Rexburg, ID 83440 www.rexburg.org Fax: 877.397.3917 REXBURG r� 1 nuru•ir I irrnrly r.irnnnump• Date Issued 1219Meter #XYR Hose;a No / Business name: I Phone # Picked up byPhone # 9(2r 3/3 g4193 Address: Y30 w 4,` P/x&d o Ty iS3 [ Year Issued: Deposit amt: (Receipt Code= WDEP) $1,600 Large Capacity Water Meter �c/i Deposit retained? or refunded? © G� $ 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. t 4rtVf& 4 e r 3. Check out the backflow and metering device from the city water dept. to be attached to the fire hydrafit 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.) S. 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 ass ed a penalty charge of $400 in addition to the normal charge for the water taken. Signature of Applicant REFUND TO: METER OK: YES OUT READ CHARGES: tut NO IN READ 3 METER MAINT 75.00 GAL. USED 0- 1000 GAL 10.00 ME READ DATE ADDITIONAL WATER N .METER RE -ISSUED? YES/NO REPAIRS -PARTS If ' •� 0Mf TOT -- T L Issued by: Received by: