HomeMy WebLinkAboutHYDRANT PERMIT - 20-00179 - Hill and Sons Excavation FHM#2235 North Ist East
Rexburg, ID 83440
Date Issued 3Q
Business name: ft,:
Picked up by
Address:
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
Noah.phetheon@rexburg.org Phone: 208.372-2136
www.rexburg.org Fax: 877.397.3917
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Meter #
Permit #
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City of Rexburg COVID 19 Emergi
In Rexburg, we are following the
Public Health Department. -that i
care of ourselves by washing fres
stay away from any poter W, cal
this time of year.
Our Police and Fire department
so they can keep our first respo
Our Parks department is impler
prevent the spread of disease 1
qc J ialko v ,,Lv 9311 a Year Issued: ull-� W orr
Deposit amt: (Receipt Code= WD Ep) with credit cards charge an dditional 3.5% (Receipt Code= MISCG) ?Ivan Harper
$1,800 - 2" Water Meter ✓ Deposit retained? or refunded?
$ 800 - 1" Water Meter ( date) I From:
CONDITIONS OF PERMIT: Sent -
In order to prevent possible contamination from backflow of the Rexburg city water system, any persons or entity r To:
desiring to obtain water from a city fire hydrant must comply with the following: Subject-,
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. t
3. Check out the backflow and metering device from the city water dept. to be attached to the fire hydrant Ivan,
agreed upon by the user and the city water deptment. e
t Thanks for the noU
4. As indicated above a deposit will be required on any metering device. Any damage to or loss of the device You had samptest
will be paid for by the user. After any use, repair, or replacement charges are deducted ,the balance of the r
did not analyze or
deposit will be refunded to the user. (City water dept. will conduct a final inspection.) 4 compoundsvery
5. The fee for any water obtained through the metering device is as follows: I want 'AIISynthe
Fee: 1— 1,000 gallons $10.00 Each 1,000 gallons thereafter : $5.00 Thanks agalnfol
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.
y 12/1 for testing calibrations. A meter can be reissued the same day per
7. The meter needs to be returned b
request if needed.
licy shall be assessed a penalty charge of $400 in addition
Any person or entity not complying with is po
t
to the normal charge for the water to Z I our ttissimi
Signa re of A plicant
I:
REFUND TO: CHARGES: ~osted From:lvi:
METER OK: YES OUT READ 75.00 time, tt Sent; Thi
+
IN READ METER MAINT
NO. 0- 1000 GAL 10.00 To: Nick
GAL. USED Subject'
READ DATE ADDITIONAL WATER
REPAIRS -PARTS I receivi
METER RE -ISSUED? YES/NO TOTAL
Received by: W
from:'
issued by: Seat.'