HomeMy WebLinkAboutHYDRANT PERMIT - 20-00163 - Kauer Construction FHM #24FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North Ist East
Noah.phetheon@rexburg.org
Phone:
208.372-2136
Rexburg, ID 83440
www.rexburg.org
fox:
877.397.3917
Date Issued . 7,
Business name: �4,i2 (_ M5V1"6Traj
Meter #
Permit #
Picked up
by l ay,
e S r-uc,iu
refunded to the
user. (City water dept.
will conduct a final inspection.)
Address:
594
dJ cG-«
IJaw icd57
CITY OF
REXBURG
ci
AmerlA Family Community
Hose Number:
Phone # Z 357 -ooc� t
Phone# L ->,Y- 705=6t5t7
Year Issued:
032D
Deposit amt: (Receipt Code= WD�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 11t 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.)
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 ofQO'i jddition
to the normal charge for the water taken. ff�� (U�
— MAR s ��k
7020`
Signa of Applicant
VT T
REFUND TO:
METER OK: YES OUT READ MAP CHARGES:
NO IN READ
GAL. USED
READ DATE
METER RE -ISSUED? YES/NCI
Issued by: / r
METER MAINT 75.00
0-1000 GAL 10.00
ADDITIONAL WATER
REPAIRS -PARTS
Received by:
TOTAL