HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00267 - Rhodehouse Construction FHM 30FIRE HYDRANT USE PERMIT
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NONTRADITIONAL WATER CUSTOMERS : RVl2T RG
1�JJ V l�
ry,
35 North l st East Noah.phetheon grexburg.org Phone: 208.371-2136 4merww: hmA,(. xmviry
Rexburg. ID 83440 www rexburg.org Fax. 877.397.3917
Date Issue 7� 1 Meter # /'/�/9JIf :?r Hose Number:
r Permit #
Business name: RkorVjII oto -a Phone # 2A)Y4Lflo •7dOL ti� FH kEy
Picked up by Zetr.. C,� r i SF.N- Phone # Zfr�7L(`.S'79S
Address: -- �3� _��_160 14!!�^ Llti �t�S
�GGi�e`dn .
' 3 2
t !� Year Issued: Al—; i),./
Deposit amt: (Receipt Code= WDE ) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
Ivan Har er $1,800 - 2" Water Meter Deposit retained? _V/� or refunded?
$ 800 - 1" Water Meter ( date)
From' CONDITIONS OF PERMIT:
Sent: In order to prevent possible contamination from backflow of the Rexburg city water system, any persons or entity
Subject:
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.
Registration 4. As indicated above a deposit will be required on any metering device. Any damage to or toss of the device
will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the
you've succes deposit will be refunded to the user. (City water dept. will conduct a final inspection.)
First name
5. The fee for any water obtained through the metering device is as follows:
Last name: Fee: 1-1,000 gallons $10.00 Each 1,000 gallons thereafter : $5.00
ti Organization: 6. A $50.00 maintenance fee for 1" and $75.00 maintenance fee for 2" will be assessed each year for
,o U3!dClass maintenance on the meter.
/S Date: 7. The meter needs to be returned by 12/1 for testing calibrations. A meter can be reissued the same day per
Time request if needed.
Location:
Address: Any person or entity not complying withs policy sha a essed ge of $400 in addition
to the normal charge for the water taken c ar
por more i
This messal
REFUND TO:
METER OK:
YES
NO
_ OUT READ
_ IN READ _
GAL. USED _
READ DATE
METER RE -ISSUED?
Issued by: NXTil S l,/7_'
YES / NO
of
_ CHARGES:
_ METER MAINT 75.00
_ 0- 1000 GAL 10.00
_ ADDITIONAL WATER
REPAIRS -PARTS
TOjj4y
Received by: Ltd `—
U il
wrirnc'k •c{- PeA rc 't#0164
Xo5.e1 ci sex td'
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Dear Mayor Nic.,,...
A sanita[Y si,,.vey was recently conducted tut tF
system. E,ncluscd with this wacr is
water
mcords.
pny significant deficlencits iden{ific end 1 L
consultation whh the \daho an are nt uired
written corrective action plan are [eq
andloc follow-uP Rqu't`nitnts IdMu I i.
SS.Ot .08. P\easy fo\\ow the tour 141 APs
si8riificant deficiencies, .
F1e advised that modificaitom to your
\ eng
licensed p[otessionamecr and Mks
system modificatiuoou os� 5 "ting'
modiGoabons to Y
Thank Sou for }out help in wmple
Fa1VsRegronal off' at 120815'-8'
questions-
S:Jnn,Qetaety.
Nlektiie\sen
Drinking W ater Analyst
Enc\osures l21'•
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