HomeMy WebLinkAboutHYDRANT PERMIT - 21-00606 - Rexburg Waste Water Collections FHM 34PO 80,V G867vA[[E)' SBS
_ 1208 33 25 p 03n Ave
PkVS
SX& 4V' 7330,0'242
URG
�X 280 C/Ty of
XBVRG 10 83440
834/nS0 8 9�
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North IstEast Noah.phetheon ®rexburg.org Phone: 208.372-2136
` Rexburg, ID 83440 www.rexburg.org Fax: 877.397.3917
Date Issued R/3/2/ Meter#iRiKi
"� yzx bw, / Permit # .21
Business name: WAa&� VA j rV Le%Z44,1 Phone #
Picked up by lji i v 400/1400/1-10-1 Phone #
r
Address:
{kAtll q„
_n� ��, ++CS�I TY �OP
7_R/_'_�_
,.' Aumdw's himily(.umenundy
Hose Number: Al&eet
Lotaiion: J'x64"
Year Issued:: Wtt
tf
Deposit amt: (Receipt Code= WDE ) with credit cards charge'a/n� additional 3.5% (Receipt Code= MISCG)
w
$1,800 - 2" Water Meter V 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 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.
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, //
0
REFUND T0: ES OUT READ /�D/7 CHARGES:
METER OK: _____ IN READ METER MAINT
G 0-1000 GAL
AL. USED
ADDITIONAL W ATER
READ DATE REPAIRS -PARTS
METER RE -ISSUED? YES / NO TOTAL
Received by: _--- —
Issued by: 01
75--�
10_ 0_0---
'08-5342445',Dat>.ny
g O7 --r_'