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HomeMy WebLinkAboutHYDRANT PERMIT - 21-00550 - BTC Contractorsp :# JapJO a awel noq i?e 7oq tiZ g 6� OtY 807 f l9 ftuej ojd ujnl [% ` v 6£gz'i 60££8 OI SIIez, S13d V�. FIRE HYDRANT USE PERMIT NONTRADITIONAL WATER CUSTOMERS $� CITY op 0 ' 35 Northlsf East Nooh.phethean®rexburg.org www.rexburg.org Phone: Fox: 208.372-2136 877.397.3917 Com' �'^•'��'F"mty <om.u,n. Rexburg, ID 83440 Date Issued .L/ lwecer Hr d y Hose Number:. Permit # 2(— DU s�Q Business name: r' �v�//74c �`osP/t� ,Ll L. Phone # ,r� r'�7 q - Z Picked up by:i� Phone# © li�� % ZFS Address: /-- � q / 2 �/ City State Zip: ��TGEGc� 6L— �✓ `V Year Issued: ,-.7 V Z / Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG) $1,800 - 2" Water Meter ✓ Deposit retained? or refunded? $ 800 - 1" 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 11` 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. 7. The meter needs to be returned by 12/1 for testing calibrations. A meter can be reissued tthe dam dda��r e� request if needed. /� r Any person or entity not complying with this policy shall be assessed a penalty arge of $400 in addition to the normal charge for the water taken. Signature of Applicant REFUND TO: METER OK: YES ✓ OUT READ CHARGES: NO IN READ METER MAINT GAL, USED 0-1000 GAL 10.00 READ DATE ADDITIONAL WATER METE RE -ISSUED? YES/NO REPAIRS -PARTS l TOTAW. , Issued by: < G�L/.� Received by: -Vi _ , �