HomeMy WebLinkAboutHYDRANT PERMIT 2 - 21-00550 - BTC Contractors FHM 22•r• \ W N! \ lL
FIRE HYDRANT USE PERMIT •°x'°• rcapunAlblc cl
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NONTRADITIONAL WATER CUSTOMERS S c Ri�yT1!T RiC 021
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35:MorthlStEost Nouh.phelheunQrexburg.org Phone: 208.372-2136 Amwkak Family [:Dmm responsible
RexD 83440 www.rexbu sYsftms are
rp.org Fax: $77.397.3917
Date Issued_PTe / / _ Meter # a S. Hose Number: ��— 03,
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Permit # _02.(- DU-s-ecO_
Business name: ����.� 1 Phone # � fJ k 11 2 6 U4
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Picked up by: � V41's 11 p Ns 4E A 1 Phone # 690 f o r accept or p
Address: A251. _ Z9S
J I/G�l((� % V' 4(Vigt4 300.
City State Zip:, (� 3
—7 V/
Issued: 0�1 i Applicant
Deposit amt: (Receipt Code= W/ DEP) with credit cards charge an additional 3.5% (Receip ode= MISCG)
$1,800 - 2" Water Meter ✓1
Deposit retained? or refunded? classifies
$ 800-111 Water Meter (date]
CONDITIONS IONS 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't 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 dam dd e�
request if needed.
Any person or entity not complying with this policy shall be assessed a penalty arge of $400 in addition
to the normal charge for the water taken.,, z _ XI
Signature of Applicant
REFUND TO:
METER OK:
YES
NO
OUT READ7 P9 _
IN READ 2y
GAL. USED
READ DATE
METE RE -ISSUED? YES/ NO
Issued by: , Gu/�^—
CHARGES:
METER MAINT
0-1000 GAL
ADDITIONAL WATER
REPAIRS
-PARTS
TOT
10.00
Received by: �, z
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