HomeMy WebLinkAboutHYDRANT PERMIT - 21-00612 - Mountain Valley Construction FHM 32 City ProjectT
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35 North Ist East
'Rexburg, ID 83440
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FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Nooh.phethean®rexburg.org Phone: 208.372-2136 '
www.rexburg.org Fox: 877.397.3917
CITY OP
REXBURG
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Date Issued Meter # //& 3.2. Hose Number: 0)'V
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+ /' Permit #
Business name: .; 1-ov,1` kkx Va(�Pv ( ryilcl�'VG fLOn Phone # d $ - c r3:71 - ef/,/q
Picked up by: d.� a ti. f L ef Phone # 4& ,i� — go y- / O
Address:
City State
Deposit at
$1,800 - 2" Water Meter
$ 800 - 1" Water Meter
locsr,ka*2: ParfC .cef
Year Issued: a God
Iditional 3.5% (Receipt Code= MISCG)
Deposit retained? or refunded?
( 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. 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.1
!VO Ckq 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.
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
to the normal
charge for
the water
taken,
lature of A
REFUND TO:
METER OK: YES OUT READ- Y
NO IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES / NO
Issued by:
be assessed a penalty chargepAQn addition
AUG - r 2021
of
CHARGES:
METER MAINT
0-1000 GAL 10.00
ADDITIONAL WATER
REPAIRS -PARTS
Received by:
TOTAL
P