HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00007 - American Vac Service FHM 24FIRE YDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
x urg,NorstEosl NOohphetheon®rexburg,or
Rexburg, Ip 783440
www.rexburg.org Phone: 208.372-1/36
Date issued, _- � g fox: 877.397.3917
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`—'"—"-- Meter!# �, �
Business name: Hose Number 2�
NPermittt a(�d400�
Picked up by `t�Q11eiG'P.�2i 7 �/
Phone J#
Address: O C —
Year Issued:
Deposit amt: (Receipt Code= WDEP) with credit cards charge a ditional 3.5% (Receip Code= M(SCG)
$1,800 - 2" Water Meter Deposit retained? a
$ 800 - 1" Water Meter or refunded.
CONDITIONS OF PERMIT: ( date)
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.
3. Checkout 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.)U ^ ?
5. The fee for any water obtained through the metering device is as follows: FBZ e
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" wlli be assessed each year for
7. The meter maintenance eon the
bee returned by 12/1 for testing calibrations. A meter can be reissued the same day per
request if needed.
I in with th+s poly shall be assessed a penalty charge of X400 in add'\Gon
Any person or entity not comp Y r '
to the normal charge for the water to en. /
:,.,,af„re of APP cap —
` �� CHARGES-
.
REFUND T0: OUT READ METER MAINT 75.00
METER OK: YES(). READ 10.00
0- 1000 GAl
a me fef
NO GAL. USED ADDITIONA\. W NITER
Gf.; S �� READ DATE ED7 YES / 0 REPAIRS -PARTS
METER RE-ISSU74" TOTAL /)
GCS, Received by: Jw
issued by: