HomeMy WebLinkAboutHYDRANT APPLICATION - 21-00744 - State of Idaho FHM 4 “State Project”Rexburg, ID 83440 www.rexburg.org Fax: 877.397.3917
Date Issued ZDJ Meter # Hose Number: -.4y2
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Permit #
Business name: ��Q,4Phone #
Picked up by rl�wnas,vi Phone #
Address: / a�
Year Issued:.a�eCetl�z
Deposit amt: (Receipt Code= W EP) 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 1s' East, before attempting to take any water. hoc of
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 ,Qeaye<`aveo�p�
agreed upon by the user and the city water deptment. ' o 0 G
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 �GJ
deposit will be refunded to the user. (City water dept. will conduct a final inspection.) 2GCP, e &\ as
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5. The fee for any water obtained through the metering device is as follows: ��S�p� O�GIN
Fee: 1-1,000 gallons $10.00 Each 1,000 gallons thereafter: $5.00 VO
6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year for r �d��e ro
maintenance on the meter. out aJ��t�g
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.
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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 tak / cs
' Signature of Applicant
REFUND TO:
METER OK: YES OUTREAD _�/a CHARGES:
NO IN READ METER MAI NT 75.00
GAL. USED 0-1000 GAL 10.00
READ DATE ADDITIONAL WATER
METER RE -ISSUED? YES/ NO REPAIRS -PARTS
Issued by: TOTAL
Received by: