HomeMy WebLinkAboutHYDRANT PERMIT - 21-00248 - Hill & Son Excavation FHM 2135 Northlst East
Rexburg, ID 83440
Date issued y
B
Business name:
Picked up by _
Address:
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Nooh.phetheansrexburg.org
Phone:
208.372-2136
www.rexburg.org
Fax:
877.397.3917
J/4
r
35 Northlst East
Rexburg, ID 83440
Date issued y
B
Business name:
Picked up by _
Address:
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Nooh.phetheansrexburg.org
Phone:
208.372-2136
www.rexburg.org
Fax:
877.397.3917
CITY OF
EXBURG
c,.. —
Amenws Family COmPWmrj'
C14 meter #) 4n 9.1 Hose Number: I?- -5`f
Permit #
CirPhone #
Phone #
Bldg 9, vj 7„ �/ ` (Y r L U Year issued: 4 ZC
/—EE
Deposit amt: (Receipt Code= WD ) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter Deposit retained? � or refunded?
( date)
$ 800 - 1" Water Meter
CONDITIONS OF PERMIT: y persons or entity
S247 in order to prevent possible contamination from backflow of the Rexburg cit water system, any p
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 1" 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.)
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.
esting calibrations. A meter can be reissued the same day per
7. The meter needs to be returned by 12/1 fort
request if needed.
Any person or entity not complying with this policy shall be assessed a penalty charge of $400 in add ition
to the normal charge for the water taken.
i
at re Applica
REFUND TO:
METER OK:
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A %tr yy
at spec,
issued by:
e anc
YES OUT READ
NO IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES/NO
CHARGES:
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL
Received by:
75.00
10.00
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