HomeMy WebLinkAboutHYDRANT PERMIT - 21-00327 - Zollinger Construction Inc FHM 3oQ�exnbA��o CITY O F
FIRE HYDRANT USE PERMITc I T V O F G
NONTRADITIONAL WATER CUSTOMERS '� ��Mi
>, Amcriiui F.mrily Cnnvnunrf)
35 North IstEast Nooh.phethean@rexburg.org Phone: 208.372-2136 „o
www.rexburg.org Fox: 877.397.3917
Rexburg,tD83440IIIIIIII Hose Number:,—
T l 3� 2_/ Meter #
ate Issued Permit #
usiness name:
o ! i �t� �
2 Phone # s/
Phone#
icked up by _ �7
tddress: 3'�
�► , �' 3 Year Issued: ii r
deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
>11800 - 2" Water Meter Deposit retained? or refunded?
(
$ 800 - 1 Water MeterIIIIIIIIIII 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 1" 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.
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.)
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
A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year for
maintenance on the meter.
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
to the normal charge for the water. / -1
REFUND TO:
METER OK:
GAL. USED _
READ DATE _
METER RE -ISSUED?
be assessed a penalty charge of $400 in addition
METER MAINT
0- 1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
Received by:
75.00
10.00