HomeMy WebLinkAboutHYDRANT PERMIT - 21-00291 - Mountain Valley Construction FHM 27reply P htac vr9'
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Rexburg, ID 83440
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
w�ah. pneineor: jrexburg-wg Phone: 208.372-21R
www.rexburg.org Fox: 877.397.3917
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low nate Issued y/2q/Z,r Meter# CITY OF
I��` Hose Number. ?- 2 RELEASE pp LIABt
�Ifo� Permit # Zj � 00A(? l I hereby A� Businessname: / -(_ (? Vytly1 v0(�I �G y acknowledge tha
�1Sf Phone # over the Meter Pit on or a
Picked up by�ly gt,tof- dangers involved- in con
Phone # afi�' (pc(-�1 letting me PavefConcrete
Address: �� r ate/ / L/L'—/—/— installing a meter in
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responsibility for the mai,
t rry Lf7 Corporation stop or Valy,
Year Issued: �Q pavement/concrete that I
Deposit amt: (Receip Code= WnFP) with credit cards charge an additional 3.5% (Receipt Code= MISCG) all risks involved
oiveit therein
$1,800 - 2" Water Meter harmless the Cit
$ Boo - 1" Water Meter Deposit retained? ✓ or refunded? from Y tit Ret
any and all liability
CONDITIONSOFPERMIT: (date) disability personal incur
In order to prevent possible contamination from backflow of the Rexburgcit waters stem, an
In iringorder
to obtain water from a city fire hydrant must com I andlConcret i engin tha
instal y y y persons or entity and concrete gin
1. Obtain a written permit from Rexburg City Hall, 35 N ly"'th the following: g instal
2. Take water only from the one fire hydrant designated by East, before attempting to take any water. Addltlonall
3. Checkout the backflow and metering device from the city water dept to be attached ttached to the fire hydrant Y, I antee thi
but
me, ttie CantraGLOr, but
agreed upon by the user and the city water deptment.
4. As indicated above a deposit will be required on an Additlonaliy, t anger, th
ce. Any
will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the tee but also Upon my I
damage to or loss of the device representatives,
deposit will be refunded to the user, (City water dept. will conduct a final ins and a
S. The fee for any water obtained through the metering device is as follows; inspection.) This
Fee: 1 - 1,000 gallons $10.00 Each 1,000 gallons thereafter : $5,00 al�geettlent steal{ t
the maximurrt extent p
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each
maintenance on the meter. year for I hereby certify that i I'
7. The meter needs to be returned by 12/1 for testing calibrations. A meter can be reissued the same da its contenig
request if needed.
AddreeS of a$aum i
Y per pt.ts.
Any person or entity not complying with this policy shall be assessed apenalty charge of $400 in addition
� 3 �
to the normal charge for the Water take
Purpose: Recatu a¢ ._ .
REFUND TO: —�—
METER OK: YES
OUT READ �
NO IN READ
GAL. USED
READ DATE _
METER RE -ISSUED?
Issued by:
YES / NO
(cant
CHARGES: ---
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
Received by: TOTAL
75.00
10.00