HomeMy WebLinkAboutHYDRANT PERMIT - 20-00300 - Mountain Valley Construction #20�
FIRE HYDRANT USE PERMIT a,,414•4v
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NONTRADITIONAL WATER CUSTOMERS f. r' r r Of
35 North lstEost �+ jJrt,r,r,�,�
Rexburg. ID 83440 r �n pherneon srexourg.org =hone: ?08.377-7136 11I:lljyj (f`(
Date I nN rexburg,org Fox. 877397.3917 "'" '.,
sued � � n ^it�---v�,,,
—`---- Meter #
Business name: Hose Number
/ Permit#�
Picked up byPhone #
/ �v�/ems Phone # Zb�—
Address:
Year Issued: ZDZQ
Deposit amt: (Receipt Code= WDEP) with credit cards charge an additional 3.5% (Receipt Code= MISCIS)
$1,800 - 2" Water Meter ✓
Deposit retained? ✓or refunded?
$ 800 - 1" Water Meter
CONDITIONS OF PERMIT: ( date)
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" 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 deptwill 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
J+Ci2er,
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 tthis�icy shall be assessed a penalty charge of 5400 in addition
to the
normal
charge
for
the water
tsar' /_ I i
REFUND TO:
METER OK: YES OUT READ 346 % CHARGES:
NO IN READ -I% METER MNINT
75.00
GAL. USED 7D 0- 1000 GAL
READ DATE ADDITIONAL W ATER
METER RE -ISSUED? YES/ REPAIRS PARTS
Received by: / F,
Issued by:
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