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HomeMy WebLinkAboutFIRE HYDRANT PERMIT - 21-00168 - Madison County Fair Grounds FHM #14Q M _ ., _._ c._..:a....., C................A..n1ar1 an SPnrn.--'- 35 North I st East Rexburg, ID 83440 Date Iss FIRE HYDRANT USE PERMIT NONTRADITIONAL WATER CUSTOMERS Noah.phetheon@rexburg.o(g Phone: 208.372-2136 www.rexburg.org Fax: 877.397.3917 Business name: lza-L16n 6,2rcne rA Picked up by KI&V I 1/145 L Address: Meter # CITY OF REXBURG Amcdw's Family Camnumay FJf/f /y Hose Nurnoer:woo PGrmt� � �l— BDI� Phone # Phone # 268 '- 3/7" 29 Year Issued:' Deposit amt: (Receipt Code= WDEP) $1,600 Large Capacity Water Meter I/ 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 1st 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. 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 TO: METER OK: YES OUT READ VY NO IN READ GAL. USED READ DATE METER RE -ISSUED? NO 4 1001 -.000 CHARGES: METER MAINT 0-1000 GAL ADDITIONAL WATER REPAIRS -PARTS TOTAI . issued by: Received by: I � 75.00 10.00 R('yuttlrur e The foll Srhedul 3100 sch d code ftu hhUIto "PLonsummeer n0ece of ked to "^'+w'oeq,glahp.gov/water Schedules for W9g: PI° label Sampling Code crou zt*3 Pl Analyt E R221 R22 soo ZNO ZNO So V l Pla; cod ZNQ r� r