HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00341 - Pine Brook Estates HOA. FHM 18or
FIRE HYDRANT USE PEKM�� s°; o REN ) ZCi
NONTRADITIONAL WATER CUSTOMERS AM
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Phone' 218.37? 21:16 .
35 North Is? East Noah. phetheonOrexburg org Fax: 877.397.3917 Hose Number:
Rexburg, ID 83440 www.rexbUr9-0rg 1 4
Meter q
Date Issued z Permit g
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Business name: Y II 4 CJVC �?1r� -�"-- r{ C phone #
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Picked up by
Address: Year issued: —V
I U Code= M15CG)
Deposit amt: (Receipt Code= WL)EP) with credit cards charge an additional 3.5% (Recel
Deposit retained? or refunded? date)
$1,800 - 2" Water Meter
$ 800 - 1" Water Meter temp any persons or entity
CONDITIONS OF PERMIT: with the following:
In order to prevent passible contaminatfonust Complylthe Rexburg city water i n to take any water.
desiring to obtain water from a city fire hydrantCity Hall, 35 N 1" East, before attempting
1. Obtain a written fper it from Rexbur hydrant designated by the city water department.
2. Take water only device from the city water dept. to be attached to the fire hydrant
3. Checkout the backflow and metering
agreed upon by the user and the city water deptment.
q 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 balanceofthe
deposit will be refunded to the user. (City water dept. will conduct a final inspection.) Pi
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.o A
REFUND TO:
METER OK: YES
NO
OUT READ i
IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES/NO
Issued by:
licant
CHARGES:
METER MAINT 75.00'
0- 1000 GAL 10.00
ADDITIONAL WATER
REPAIRS -PARTS
TOTAL Q
Received by: L
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