HomeMy WebLinkAboutHYDRANT PERMIT 2 - 20-00240 - SCC Construction FHM #86n
�-1 S
1
20 �
5,5�tL
VC
,¢/?
Alt
4�.
b:S` � k
G yS� /' 4
FIRE HYDRANT USE PERMIT
NONTRADITIONAL WATER CUSTOMERS
35 North IStEast
Noch.phethean®rexburg.org
Phone:
208.372-2136
Rexburg, ID 83440
www.rexburg.org
Fax:
877.397.3917
Date Issued
Meter #
+o �� CITY OF
REXBURG
nv
America} FamRy Cummunllr
Hose Number:_
/ Permit #
Business name: �L,(� C_r'j4�rl44,1i o Ip Phone # "s ZI- 313 - 1 lea
I PAIL)
�..
Picked up by ��r v WISLS / Phone #
Address: 4�-00o North
APR 17 2020
Et2t Lla'� Year Issued: "lty nf PPVh,IIV
4
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCG)
$1,800 - 2" Water Meter _ Deposit retained? or refunded? 1
$ 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 I" 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 Voss 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.)
S. 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.
ing calibrations. A meter can be reissued the same day per
7. The meter needs to be returned by 12/1 for test
request if needed.
th this policy shall be assessed a penalty charge of $400 in addition
Any person or entity not complying wl
to the normal charge for the water takQ,rl?
Signature of Applicant
REFUND TO:01TREAD ZE*l
METER OK: YES
NO _ IN READ�_L— —
GAL. USED
READ DATE
METER RE -ISSUED? YES/NO
Issued by: L ``t —
CHARGES:
METER MAINT
0-1000 GAL
ADDITIONAL WATER
REPAIRS -PARTS
75.00
10.00
T /
Received by:
�G lot K �
r �" r
J%